Navegando por Palavras-chave "Ankylosing Spondylitis"
Agora exibindo 1 - 4 de 4
Resultados por página
Opções de Ordenação
- ItemSomente MetadadadosManejo clínico de pacientes com espondilite anquilosante: o papel da ressonância magnética de coluna vertebral total para a tomada de decisão(Universidade Federal de São Paulo (UNIFESP), 2021) Bendahan, Louise Tandaya [UNIFESP]; Pinheiro, Marcelo De Medeiros [UNIFESP]; Universidade Federal de São PauloThe lack of specific biomarkers to evaluate disease activity in patients with ankylosing spondylitis (AS) is a relevant challenge in clinical practice. Some conditions, including fibromyalgia, chronic spine damage and other causes of non-inflammatory back pain, need to be considered as differential diagnosis before making clinical decision, such as biological therapy, rehabilitation or global pain management. Aim: To assess the role of total spine magnetic resonance imaging (MRI) in AS patients with clinical doubt between activity or chronicity in short and in long-term. Patients and Methods: A total of 57 AS patients, according to New York criteria, were included in this 2-year prospective study. The main inclusion criterion was the clinical doubt between disease activity or not disease activity, considering standard tools, such as mechanical or inflammatory back pain, peripheral arthritis or enthesitis, extra-articular manifestations and C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). The patients were divided in 2 groups (A: patients with pain and low CRP and ESR serum levels; B: patients no symptoms but with high CRP and ESR serum levels). All patients performed total spine MRI, including cervical, thoracic and lumbar spine. The reading was performed by a blind radiologist, considering the SPARCC (Spondyloarthritis Research Consortium of Canada) methodology, and the rheumatologist used it to make the major clinical decision. A positive spine MRI was defined when 3 or more bone marrow edema (BME) signals were found, according to the OMERACT proposal. Results: Positive MRI was observed in 40% and 30% of group A and B, respectively. Using the global evaluation (clinical, lab and imaging information) performed by expert rheumatologist as gold-standard, the concordance between positive MRI and overall disease activity was observed in almost 70% of AS patients (r=0.36, p=0.01), especially in group A. On the other hand, higher inflammation severity and area score was more found in group B than group A (15.7±7.5 and 9.9±6.7; p=0.048; respectively). After 12 and 24 months of follow-up, all patients were re-evaluated and the most of them still remained with the same medical decision, suggesting good assertiveness of whole spine MRI over time. Conclusions: Our data showed whole spine MRI could be used as an important tool for making the diagnosis differential and more adequate clinical decision between disease activity and other non-inflammatory causes of pain in patients with AS.
- ItemSomente MetadadadosQuality of life in spondyloarthritis: analysis of a large brazilian cohort(Elsevier science inc, 2016) Ribeiro, Sandra L. E.; Albuquerque, Elisa N.; Bortoluzzo, Adriana B.; Goncalves, Celio R.; Braga da Silva, Jose Antonio; Ximenes, Antonio Carlos; Bertolo, Manoel B.; Keiserman, Mauro; Menin, Rita; Skare, Thelma L.; Carneiro, Sueli; Azevedo, Valderilio F.; Vieira, Walber P.; Bianchi, Washington A.; Bonfiglioli, Rubens; Campanholo, Cristiano; Carvalho, Hellen M. S.; Costa, Izaias P.; Pinto Duarte, Angela L. B.; Kohem, Charles L.; Leite, Nocy H.; Lima, Sonia A. L.; Meirelles, Eduardo S.; Pereira, Ivelnio A.; Pinheiro, Marcelo M. [UNIFESP]; Polito, Elizandra; Resende, Gustavo G.; Rocha, Francisco Airton C.; Santiago, Mittermayer B.; Sauma, Maria de Fatima L. C.; Valim, Valeria; Sampaio-Barros, Percival D.Objective: To analyze quality of life and demographic and clinical variables associated to its impairment in a large Brazilian cohort of patients with spondyloarthritis (SpA). Methods: A common protocol of investigation was applied to 1465 Brazilian patients classified as SpA according to the European Spondyloarthropaties Study Group (ESSG) criteria, attended at 29 reference centers for Rheumatology in Brazil. Clinical and demographic variables were recorded. Quality of life was analyzed through the Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire. Results: The mean ASQoL score was 7.74 (+/- 5.39). When analyzing the specific diseases in the SpA group, the ASQoL scores did not present statistical significance. Demographic data showed worse scores of ASQoL associated with female gender (p = 0.014) and African Brazilian ethnicity (p <0.001). Regarding clinical symptoms, buttock pain (p = 0.032), cervical pain (p <0.001) and hip pain (p = 0.001), were statistically associated with worse scores of ASQoL. Continuous use of nonsteroidal anti-inflammatory drugs (p < 0.001) and biologic agents (p = 0.044) were associated with higher scores of ASQoL, while the other medications did not interfere with the ASQoL scores. Conclusion: In this large series of patients with SpA, female gender and African-Brazilian ethnicity, as well as predominant axial symptoms, were associated with impaired quality of life. (C) 2015 Elsevier Editora Ltda. All rights reserved.
- ItemSomente MetadadadosRenal abnormalities in Ankylosing Spondylitis(Scandinavian University Press, 1997-01-01) Vilar, Maria José Pereira [UNIFESP]; Cury, Silvia Elisa [UNIFESP]; Ferraz, Marcos Bosi [UNIFESP]; Sesso, Ricardo de Castro Cintra [UNIFESP]; Atra, Edgard [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Renal abnormalities have been reported in Ankylosing Spondylitis (AS) patients. Possible mechanisms include the effects of nonsteroidal anti-inflammatory drugs (NSAIDs), an increased incidence of glomerulonephritis, particularly the ones associated with deposition of IgA-containing immune complexes and the renal deposition of amyloid. These observations prompted us to evaluate in detail the frequency and severity of renal dysfunction in 40 AS patients, consecutively selected attending the rheumatology disease unit outpatient clinic at Escola Paulista de Medicina, using sensitive tests of glomerular and tubular function. Fourteen of the 40 patients presented one or more signs of renal involvement: microscopic hematuria (9 patients), microalbuminuria (4 patients), decreased renal function assessed by serum creatinine (2 patients), and creatinine clearance (4 patients). None of the patients presented increased urinary excretion of retinol binding protein (RBP). The finding of renal abnormalities in 35% of our patients suggests that in this illness evidence of renal involvement should be actively investigated.
- ItemAcesso aberto (Open Access)The skin tissue is adversely affected by TNF-alpha blockers in patients with chronic inflammatory arthritis: a 5-year prospective analysis(Faculdade de Medicina / USP, 2013-09-01) Machado, Natália Pereira [UNIFESP]; Reis Neto, Edgard Torres dos [UNIFESP]; Soares, Maria Roberta Melo Pereira [UNIFESP]; Freitas, Daniele S.; Porro, Adriana Maria [UNIFESP]; Ciconelli, Rozana Mesquita [UNIFESP]; Pinheiro, Marcelo de Medeiros [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: We evaluated the incidence of and the main risk factors associated with cutaneous adverse events in patients with chronic inflammatory arthritis following anti-TNF-α therapy. METHODS: A total of 257 patients with active arthritis who were taking TNF-α blockers, including 158 patients with rheumatoid arthritis, 87 with ankylosing spondylitis and 12 with psoriatic arthritis, were enrolled in a 5-year prospective analysis. Patients with overlapping or other rheumatic diseases were excluded. Anthropometric, socioeconomic, demographic and clinical data were evaluated, including the Disease Activity Score-28, Bath Ankylosing Spondylitis Disease Activity Index and Psoriasis Area Severity Index. Skin conditions were evaluated by two dermatology experts, and in doubtful cases, skin lesion biopsies were performed. Associations between adverse cutaneous events and clinical, demographic and epidemiological variables were determined using the chi-square test, and logistic regression analyses were performed to identify risk factors. The significance level was set at p<0.05. RESULTS: After 60 months of follow-up, 71 adverse events (73.85/1000 patient-years) were observed, of which allergic and immune-mediated phenomena were the most frequent events, followed by infectious conditions involving bacterial (47.1%), parasitic (23.5%), fungal (20.6%) and viral (8.8%) agents. CONCLUSION: The skin is significantly affected by adverse reactions resulting from the use of TNF-α blockers, and the main risk factors for cutaneous events were advanced age, female sex, a diagnosis of rheumatoid arthritis, disease activity and the use of infliximab.