Advances in Rheumatology

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EISSN : 2523-3106
Published by: Springer Nature (10.1186)
Total articles ≅ 215
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Published: 9 October 2021
Advances in Rheumatology, Volume 61, pp 1-7; https://doi.org/10.1186/s42358-021-00218-z

Abstract:
Background Osteoarthritis is the most common form of hand arthritis and arthritis of the carpometacarpal joint of the thumb is a potentially limiting disease. There is no homogeneity in the evaluation of outcomes for the rhizarthrosis treatment. In an attempt to standardize the evaluation of results, some subjective questionnaires, non-specific, were used to evaluate rhizarthrosis. Trapeziometacarpal Arthrosis Symptoms and Disability (TASD) was described by Becker et al.with the purpose of evaluating symptom intensity and degree of disability, as to compare results after treatment. Our objective is to translate, validate and do the cultural adaptation of the questionnaire TASD into the Brazilian Portuguese. Methods The questionnaire was translated, with reverse translation. The translations were evaluated and synthesized by a committee, arriving at TASD-BR. Thirty-one patients with a diagnosis of rhizarthrosis answered the questionnaire. We evaluated, the internal consistency, reliability, agreement and ceiling and floor effect for validation. Results The questionnaires were translated and adapted according to defined protocols. The internal consistency, through Cronbach's α coefficient for TASD-BR, was 0.927. The questionnaire's reliability, through the Intraclass Correlation Coefficient, was also shown to be quite high, with κ = 0.961 (0.954–0.967). The agreement, measured through the Standard Error Measurement, remained with standardized values below 5%. There was no ceiling and floor effect. Conclusion Through specific methodology we consider TASD-BR translated and valid for the Brazilian Portuguese.
Gecilmara Salviato Pileggi, , Ana Paula Monteiro Gomides Reis, Edgard Torres Reis-Neto, Mirhelen Mendes Abreu, Cleandro Pires Albuquerque, Nafice Costa Araújo, Ana Beatriz Bacchiega, Dante Valdetaro Bianchi, Blanca Bica, et al.
Published: 7 October 2021
Advances in Rheumatology, Volume 61, pp 1-11; https://doi.org/10.1186/s42358-021-00217-0

Abstract:
Background There is a lack of information on the role of chronic use of hydroxychloroquine during the SARS-CoV-2 outbreak. Our aim was to compare the occurrence of COVID-19 between rheumatic disease patients on hydroxychloroquine with individuals from the same household not taking the drug during the first 8 weeks of community viral transmission in Brazil. Methods This baseline cross-sectional analysis is part of a 24-week observational multi-center study involving 22 Brazilian academic outpatient centers. All information regarding COVID-19 symptoms, epidemiological, clinical, and demographic data were recorded on a specific web-based platform using telephone calls from physicians and medical students. COVID-19 was defined according to the Brazilian Ministry of Health (BMH) criteria. Mann–Whitney, Chi-square and Exact Fisher tests were used for statistical analysis and two binary Final Logistic Regression Model by Wald test were developed using a backward-stepwise method for the presence of COVID-19. Results From March 29th to May 17st, 2020, a total of 10,443 participants were enrolled, including 5166 (53.9%) rheumatic disease patients, of whom 82.5% had systemic erythematosus lupus, 7.8% rheumatoid arthritis, 3.7% Sjögren’s syndrome and 0.8% systemic sclerosis. In total, 1822 (19.1%) participants reported flu symptoms within the 30 days prior to enrollment, of which 3.1% fulfilled the BMH criteria, but with no significant difference between rheumatic disease patients (4.03%) and controls (3.25%). After adjustments for multiple confounders, the main risk factor significantly associated with a COVID-19 diagnosis was lung disease (OR 1.63; 95% CI 1.03–2.58); and for rheumatic disease patients were diagnosis of systemic sclerosis (OR 2.8; 95% CI 1.19–6.63) and glucocorticoids above 10 mg/ day (OR 2.05; 95% CI 1.31–3.19). In addition, a recent influenza vaccination had a protective effect (OR 0.674; 95% CI 0.46–0.98). Conclusion Patients with rheumatic disease on hydroxychloroquine presented a similar occurrence of COVID-19 to household cohabitants, suggesting a lack of any protective role against SARS-CoV-2 infection. Trial registration Brazilian Registry of Clinical Trials (ReBEC; RBR – 9KTWX6).
Yu Fu, Qing Lin, Zhi-Rong Zhang
Published: 19 September 2021
Advances in Rheumatology, Volume 61, pp 1-11; https://doi.org/10.1186/s42358-021-00215-2

Abstract:
Objective To more precisely estimate the association between the tumor necrosis factor ligand superfamily member 4 (TNFSF4) gene polymorphisms and systemic lupus erythematosus (SLE) susceptibility, we performed a meta-analysis on the association of the following single nucleotide polymorphisms (SNPs) of TNFSF4 with SLE: rs1234315, rs844648, rs2205960, rs704840, rs844644, rs10489265. Methods A literature-based search was conducted using PubMed, MEDLINE, Embase, Web of Science databases, and Cochrane Library databases to identify all relevant studies. And the association of TNFSF4 gene polymorphisms and SLE susceptibility was evaluated by pooled odds ratio (OR) with 95% confidence interval (CI). Results The meta-analysis produced overall OR of 1.42 (95% CI 1.36–1.49, P < 0.00001), 1.41 (95% CI 1.36–1.46, P < 0.00001) and 1.34 (95% CI 1.26–1.42, P < 0.00001) for the rs2205960, rs1234315 and rs704840 polymorphisms respectively, confirming these three SNPs confer a significant risk for the development of SLE. On the other hand, the meta-analysis produced overall OR of 0.92 (95% CI 0.70–1.21, P = 0.54) for the rs844644 polymorphism, suggesting no significant association. And no association was also found between either rs844648 1.11 (OR 1.11, 95% CI 0.86–1.43, P = 0.41) or rs10489265 (OR 1.17, 95% CI 0.94–1.47, P = 0.17) polymorphism with SLE susceptibility, respectively. Conclusions Our meta-analysis demonstrated that the TNFSF4 rs2205960, rs1234315 and rs844840 SNPs was significantly associated with an increased risk of SLE.
, Fabianna Resende Jesus Moraleida, Cristiane Vitaliano Graminha, , ,
Published: 16 September 2021
Advances in Rheumatology, Volume 61, pp 1-8; https://doi.org/10.1186/s42358-021-00216-1

Abstract:
Background Fibromyalgia syndrome (FMS) is both a challenging and disabling condition. The International Association for the Study of Pain (IASP) classifies FMS as chronic primary pain, and it can negatively impact individuals’ functioning including social, psychological, physical and work-related factors. Notably, while guidelines recommend a biopsychosocial approach for managing chronic pain conditions, FMS assessment remains clinical. The WHODAS 2.0 is a unified scale to measure disability in the light of the International Classification of Functioning, Disability and Health. Thus, this study aimed to evaluate the reliability and validity of the Brazilian version of WHODAS 2.0 for use in individuals with FMS. Methods Methodological study of the validity and reliability of the Brazilian version of the 36-item WHODAS 2.0 with 110 individuals with FMS. The instrument gives a score from 0 to 100, the higher the value, the worse the level of functioning. We assessed participants with Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) (0–100), Fibromyalgia Impact Questionnaire (FIQ) (0–10) and Beck Depression Inventory instrument (BDI) (0–63). The construct validity, internal consistency, and test–retest stability. We used SF-36, FIQ and BDI to study construct validity analysis. For statistical analysis, we performed the intraclass correlation (ICC), Spearman correlation, and Cronbach's alpha, with a statistical level of 5%. Results Most participants were female (92.27%), aged 45 (± 15) years. The test–retest reliability analysis (n = 50) showed stability of the instrument (ICC = 0.54; ρ = 0.84, p < 0.05). The test–retest correlation between the domains was moderate to strong (ρ > 0.58 and < 0.90). Internal consistency was satisfactory for total WHODAS 2.0 (0.91) and also for domains, ranging from 0.44 to 0.81. The construct validity showed satisfactory values with all moderately correlated with WHODAS 2.0 instruments (> 0.46 and < 0.64; p < 0.05). WHODAS 2.0 evaluates the functioning encompassing components of health-related quality of life, functional impact, and depressive symptoms in those with FMS. Conclusions WHODAS 2.0 is a reliable and valid instrument to evaluate functioning of Brazilians with FMS. It provides reliable information on individuals' health through of a multidimensional perspective, that allows for individual-centered care.
Sara Pezzato, Chiara Bonetto, , Simona Tomassi, Ilaria Montanari, Maria Giulia Gnatta, Elena Fracassi, Doriana Cristofalo, Maurizio Rossini, Antonio Carletto, et al.
Published: 15 September 2021
Advances in Rheumatology, Volume 61, pp 1-9; https://doi.org/10.1186/s42358-021-00214-3

Abstract:
Introduction Depression is a quite common comorbidity in patients with rheumatoid arthritis (RA) and is thought to influence its severity. This study aims to estimate, in a large cohort of Italian patients with RA, the prevalence of depression and to investigate the clinical correlates of depression in terms of disease activity and disability. Methods This is a cross-sectional study enrolling 490 outpatients with RA (80% female, mean age 59.5). The Hospital Anxiety and Depression Scale (HADS) was used to assess the presence of depression with a cut-off of 11. We collected data about disease activity and disability with DAS28, TJC-68, PhGA, PGA, VAS, DAS28, SDAI, CDAI and HAQ. Results Prevalence of depression was 14.3% (95% CI: 11-17%). Depressed patients, when compared with not depressed ones, were found to have higher scores for TJC-68 (p = 0.011), PhGA (p = 0.001), PGA (p = 0.001), VAS (p = 0.001), DAS28 (p = 0.007), SDAI (p = 0.001), CDAI (p = 0.001) and HAQ (p = 0.001). Out of the 70 depressed patients, 30 subjects, already known to be depressed in the past, were still depressed at the time of the assessment, with only 11 (15.7%) under antidepressants. A multivariate analysis showed that male sex, higher PGA score, use of antidepressants and higher HAQ score were significantly associated with an increased risk of depression. Conclusions Our study shows that depression is common in RA and may affect its activity mainly via an alteration in the perception of the disease. Although its important implications, depression is still under-diagnosed and its management is inadequate.
Maria de la Vega, Generoso Guerra Bautista, Ricardo Machado Xavier, César Pacheco-Tena, Gastón Solano, Ronald D. Pedersen, Annette Eva Szumski, Cecilia Borlenghi, Karina Santana, Bonnie Vlahos
Published: 8 September 2021
Advances in Rheumatology, Volume 61, pp 1-8; https://doi.org/10.1186/s42358-021-00213-4

Abstract:
Background Determining potential predictors of clinical response would allow a more personalized rheumatoid arthritis (RA) treatment approach in heterogeneous populations such as Latin American (LA) patients. Methods Post hoc analysis to identify baseline characteristics predictive of clinical remission in response to treatment with etanercept (ETN) plus methotrexate (MTX) in LA patients with moderate to severe MTX-resistant RA. We report data from the group of patients who received ETN 50 mg/week plus MTX (ETN + MTX, n = 281) in a clinical trial consisting of an initial 24-week open-label phase, followed by a 104-week extension. Remission was defined as 28-joint Disease Activity Score with erythrocyte sedimentation rate (DAS28-ESR) score < 2.6. Cutoff values to dichotomize baseline variables maximizing the detection of remission were obtained from Receiver Operator Curve analyses. Baseline dichotomized and categorical variables were analyzed altogether in a stepwise logistic regression model. Odds of attaining response at Weeks 24 and 128 were estimated for each significant predictor. Results At Week 24 and Week 128, 27% (66/241) and 42% (91/219) of patients in the ETN + MTX group achieved remission. On average, patients achieving remission were younger and had lower baseline ESR, lower Physician Global Assessment (PGA) scores, lower total Health Assessment Questionnaire (HAQ) scores, and lower visual analog scale (VAS) Pain scores compared with patients who did not achieve remission. The best subset of baseline variables predicting Week 24 remission in the stepwise regression model were age ≤ 49 years (odds ratio [OR] 2.93), body mass index (BMI) > 28.5 kg/m2 (OR 3.24), disease duration > 3.7 years (OR 2.22), ESR ≤ 42 mm/h (OR 2.72), PGA ≤ 6 (OR 3.21), tender joint count ≤ 14 (OR 2.25), and total HAQ score ≤ 1.6 (OR 2.86). At Week 128, age ≤ 42 years (OR 2.21), SF-36 Mental Health Scale score > 39.6 (OR 2.16), White race (OR 4.07), > 18 swollen joints (OR 2.11), and VAS Pain ≤ 41 (OR 6.05) at baseline were the best subset of significant predictors of remission. Conclusions In LA patients with RA, younger age, higher BMI, longer disease duration, higher SF-36 Mental Health Scale score, higher swollen joint count, and overall lower disease activity predicted clinical response to ETN + MTX therapy. Trial registration: ClinicalTrials.gov Identifier: NCT00848354.
Fabiola Reis Oliveira, Valeria Valim, Sandra Gofinet Pasoto, Marilena Leal Mesquita Silvestre Fernandes, Maria Lucia Lemos Lopes, Sonia Cristina De Magalhães Souza Fialho, Aysa César Pinheiro, Laura Caldas dos Santos, Simone Appenzeller, Tania Fidelix, et al.
Published: 3 September 2021
Advances in Rheumatology, Volume 61, pp 1-13; https://doi.org/10.1186/s42358-021-00208-1

Abstract:
Sjogren's syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs. Women with SS often experience gynecological symptoms due to the disease and need extra care regarding their sexual activity, reproductive health and during pregnancy, conditions that are not properly conducted in the clinical practice. To cover this gap, a panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis on the identification of symptoms, diagnosis, monitoring, prognosis, and treatment of these manifestations. A Focus Group meeting was held and included experts in the field and methodologists, based on a previously developed script, with themes related to the objective of the study. The most important topics were summarized and 11 recommendations were provided.
Published: 3 September 2021
Advances in Rheumatology, Volume 61, pp 1-7; https://doi.org/10.1186/s42358-021-00211-6

Abstract:
Background Anti-rheumatic drugs can increase the predisposition to infection, and patients may be unaware of continuing their treatment during the COVID-19 pandemic. Objective This study aimed to assess whether patients maintain their treatment for rheumatic conditions during the pandemic period and determine the factors responsible for discontinuation. Methods Patients were randomly selected from the prospectively collected database of our tertiary referral center. The patients were interviewed by telephone through a standardized closed-ended questionnaire, which is targeting the continuity of the treatment plan and the considerations related to the individual choice. The patients were asked whether they hesitated to visit the hospital for follow-up or intravenous drug administration. Results A total of 278 patients completed the questionnaire. While 62 of the patients (22.3%) had reduced or interrupted the treatment, only 11 patients (3.9%) stopped the treatment completely. A significant difference was observed between the duration of illness and the discontinuation of treatment. (p = 0.023) There was a significant difference in disease activity between the group that stopped treatment and continued treatment. (p = 0.001) There was no statistically significant difference in other demographic characteristics. One hundred thirty-five patients (48.6%) made the treatment decision by themselves, and 80% continued the treatment. Reasons for stopping the treatment were anxiety (48.4%), not being able to go to the hospital for intravenous treatment (45.1%), and not being able to find the drug (6.5%). Conclusion Since patients with long-term illnesses were found to be significantly more likely to stop their treatment, this group of patients should be monitored.
Francisco Paulin, Anastasia Secco, Federico Benavidez, Juan José Rodríguez Moncalvo, Orlando Gabriel Carballo, Fernanda Ingenito, Martin Eduardo Fernández, Agustina Cáceres, Fabian Caro, Patricia Sasaki, et al.
Published: 24 August 2021
Advances in Rheumatology, Volume 61, pp 1-7; https://doi.org/10.1186/s42358-021-00209-0

Abstract:
Background Clinically evident interstitial lung disease (ILD) affects between 10 and 42% of the patients with rheumatoid arthritis (RA). Airway involvement seems to be even more common. Most of the available evidence comes from studies performed in established RA patients. The aim of our study was to know the prevalence of non-diagnosed lung disease (airway and interstitial involvement) in patients with early RA and look for associated factors. Methods We designed an observational, multicenter, cross-sectional study, and included patients with RA of less than two years since diagnosis. We performed a structured questionnaire, HRCT and lung functional tests looking for lung disease, together with joint disease evaluation. We analyzed which variables were associated with the presence of lung disease on HRCT. Results We included 83 patients, 83% females. The median (IQR) of time since RA diagnosis was 3 (1–6) months. In the HRCT, 57 patients had airway compromisea (72%), and 6 had interstitial abnormalities (7.5%). The most common altertion found in lung functional tests was a reduced DLCO (14%). The presence of at least one abnormality in the physical exam was associated with lung involvement on HRCT [13 (21.6%) vs 0 (0%); p = 0.026]. Also, patients with lung involvement presented significantly lower values of FVC% and DLCO%, and higher values of RV/TLC. No variable related to joint involvement was found associated with alterations in HRCT. Conclusion Our study shows that a large proportion of early RA patients has abnormal findings in HRCT. Further studies are required to confirm these findings.
, Alp Çetin
Published: 23 August 2021
Advances in Rheumatology, Volume 61, pp 1-7; https://doi.org/10.1186/s42358-021-00210-7

Abstract:
Background The aim of this study was to evaluate social media use in patients with fibromyalgia syndrome (FMS) and determine the effect of social media use on disease severity and sleep quality. Materials and methods In total, 205 social media using patients with similar characteristics were included in the study. The study group consisted of 103 patients with FMS, and the control group consisted of 102 patients without FMS. The FMS symptom severity scale and diffuse pain index were used to determine the disease severity in FMS patients, the sleep disorder short form questionnaire (PROMIS) was used to evaluate sleep quality, and the Social Media Addiction Scale-Adult Form was used to evaluate social media addiction. A visual analog scale was applied to evaluate pain in both the patient and control groups, and social media usage times were recorded. Results We found that pain severity, sleep disturbance and social media addiction were higher in patients with FMS than in the control group, and there was no relationship between the rates of social media use in patients with FMS and the severity and prevalence of the disease. Conclusion The use of social media is more frequent in patients with FMS, which can motivate healthcare professionals to evaluate social media habits in individuals with FMS.
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