Fernando Saraiva - Academia.edu (original) (raw)

Papers by Fernando Saraiva

Annals of the Rheumatic Diseases

ObjectivesTo assess the sensitivity to change of ultrasound halo features and their association w... more ObjectivesTo assess the sensitivity to change of ultrasound halo features and their association with disease activity and glucocorticoid (GC) treatment in patients with newly diagnosed giant cell arteritis (GCA).MethodsProspective study of patients with ultrasound-confirmed GCA who underwent serial ultrasound assessments of the temporal artery (TA) and axillary artery (AX) at fixed time points. The number of segments with halo and maximum halo intima–media thickness (IMT) was recorded. Time points in which >80% of patients were assessed were considered for analysis. Halo features at disease presentation and first relapse were compared.Results49 patients were assessed at 354 visits. Halo sensitivity to change was assessed at weeks 1, 3, 6, 12 and 24 and showed a significant standardised mean difference between all time points and baseline for the TA halo features but only after week 6 for the AX halo features. The number of TA segments with halo and sum and maximum TA halo IMT sho...

Frontiers in Medicine

Ultrasound-guided synovial biopsy is a safe, well-tolerated, and effective method to collect good... more Ultrasound-guided synovial biopsy is a safe, well-tolerated, and effective method to collect good-quality synovial tissue from all types of joints for clinical and research purposes. Although synovial biopsy cannot be used to distinguish between types of inflammatory rheumatic disease, analysis of synovial tissue has led to remarkable advances in the understanding of the pathobiology of rheumatoid arthritis and other inflammatory rheumatic diseases. Synovitis is the hallmark of these diseases; hence, accessing the core of the pathological process, synovial tissue, provides an opportunity to gather information with potential diagnostic and prognostic utility.

RMD Open

The coronavirus disease 2019 (COVID-19) pandemic has come with many challenges for healthcare pro... more The coronavirus disease 2019 (COVID-19) pandemic has come with many challenges for healthcare providers and patients alike. In addition to the direct burden it has placed on societies and health systems, it had a significant impact in the care of patients with chronic diseases, as healthcare resources were deployed to fight the crisis, and major travel and social restrictions were adopted. In the field of rheumatology, this has required notable efforts from departments and clinicians to adapt to the novel status quo and assure the follow-up of patients with rheumatic and musculoskeletal diseases. In the present viewpoint, we provide a practical approach to tackle this reality. Key measures include setting up preventive team management strategies, optimising communication with patients and reorganising patient care in all its dimensions. We then anticipate the nuances of rheumatology practice as restrictive measures are progressively lifted, while an effective vaccine is still pendin...

Arthritis Care & Research

Acta reumatologica portuguesa

JCR: Journal of Clinical Rheumatology

The vertebral column from a known case of Wilson's disease (hepatolenticular degeneration... more The vertebral column from a known case of Wilson's disease (hepatolenticular degeneration) was examined by radiological, histological, histochemical and x-ray microanalytical techniques which demonstrated the presence of focal depositions of calcium pyrophosphate dihydrate (CPPD) in the intervertebral discs. These deposits were present in both the annulus fibrosus and the nucleus pulposus but in certain discs the deposits were concentrated near the interface between disc and vertebral body bone endplates. At these sites there was new bone formation with narrowing of the discs, irregularity and sclerosis of the bone endplates and exostosis.

Nutricion hospitalaria, Jun 5, 2017

Fibromyalgia is a chronic rheumatic disease producing widespread pain, associated to a major como... more Fibromyalgia is a chronic rheumatic disease producing widespread pain, associated to a major comorbidity -irritable bowel syndrome. Low FODMAPS diet (low fermentable oligo-di-mono-saccharides and polyols diet) has been effective in controlling irritable bowel syndrome symptoms. Overweight is an aggravating factor for fibromyalgia. We studied effects of low fermentable oligo-di-mono-saccharides and polyols diets on fibromyalgia symptoms and weight status. A longitudinal study was performed on 38 fibromyalgia patients using a four-week, repeated assessment as follow: M1 = first assessments/presentation of individual low fermentable oligo-di-mono-saccharides and polyols diet; M2 = second assessments/reintroduction of FODMAPs; M3 = final assessments/nutritional counselling. The assessment instruments applied were: Fibromyalgia Survey Questionnaire (FSQ); Severity Score System (IBS-SSS); visual analogic scale (VAS). Body mass-index/composition and waist circumference (WC) were also measu...

Scandinavian Journal of Pain, 2016

Background and aims Fibromyalgia (FM) is a chronic, rheumatic disease characterized by widespread... more Background and aims Fibromyalgia (FM) is a chronic, rheumatic disease characterized by widespread myofascial pain, of unknown aetiology, having a major impact on quality of life (QOL). Available pharmacotherapy for FM is marginally effective. FM is associated with co-morbidities of gastrointestinal (GI) disorders and Irritable Bowel Syndrome (IBS). There is growing evidence that diets low in FODMAPs, “fermentable oligo-, di- or mono-saccharides and polyols” [Low FODMAP Diet (LFD)], are effective in treating IBS. The aim of this pilot study was to examine the effects of LFDs on symptoms of FM, especially with regard to pain, QOL and GI disorders. Methods A longitudinal study using LFD intervention was performed on 38, 51±10 year-old, female patients diagnosed with FM for an average of 10 years, based on ACR (American College of Rheumatology) 2010 criteria. The study was conducted from January through May, 2015, using a four-week, repeated-assessment model, as follows: Moment 0 – intr...

Clinical and experimental rheumatology

Routine histologic techniques are still the main procedure in the study of the synovial biopsy. T... more Routine histologic techniques are still the main procedure in the study of the synovial biopsy. The relationship between the typical histological changes of rheumatoid synovium and clinical manifestations has not been studied in detail. With the aim of determining whether a simple semiquantitative method of evaluating the changes in closed synovial biopsies was of clinical value in assessing both the diagnosis and prognosis of rheumatoid arthritis (RA) patients, we evaluated retrospectively 72 synovial biopsy specimens (26 RA patients, 30 patients with other inflammatory diseases and 16 osteoarthritis patients). Scores (0-10) were assigned to each biopsy specimen for each of 6 histologic features: synoviocyte hyperplasia; fibrosis in the subsynovial layer; proliferating blood vessels; perivascular infiltrates of lymphocytes; focal aggregates of lymphocytes; and diffuse infiltrates of lymphocytes. Scores were compared between the 3 groups and also between the RA subgroups with early ...

Acta reumatológica portuguesa

Revista Brasileira de Reumatologia, 2004

Objetivo: caracterizar as manifestações clínicas, exócrinas e não exócrinas, de 74 pacientes com ... more Objetivo: caracterizar as manifestações clínicas, exócrinas e não exócrinas, de 74 pacientes com síndrome de Sjögren primária (SSp). Métodos: estudo retrospectivo dos pacientes com SSp de acordo com os novos critérios americano-europeus de 2002, seguidos no serviço de reumatologia e doenças ósseas metabólicas do Hospital de Santa Maria (HSM) nos últimos 25 anos (média de seguimento de 7,7 anos). Resultados: todos os pacientes apresentaram doença exócrina dos epitélios superficiais, com destaque para a xerostomia e a queratoconjuntivite seca. Doença exócrina dos órgãos internos foi encontrada em 25 pacientes (33,8%), enquanto apenas um paciente (1,4%) desenvolveu doença linfocitária B monoclonal (pseudolinfoma pulmonar). Do total, 55 pacientes (74,3%) também apresentaram manifestações não-exócrinas, com predomínio das induzidas por mediadores da inflamação (68,9%). As manifestações vasculares inflamatórias estiveram presentes em 54% dos pacientes e as vasculares não-inflamatórias em 27%. A tiroidite auto-imune surgiu em 5 pacientes (6,8%). Conclusões: os componentes oral e ocular dominam a doença, sendo mais limitadas as manifestações orgânicas graves. Este modelo classificativo permite comparar alterações fisiopatológicas entre os pacientes e abre uma via de estudo para encontrar marcadores de atividade/ cronicidade com estas relacionados.

Seminars in Arthritis and Rheumatism, 2010

A survey was performed in 5 European countries (France, Germany, Italy, Portugal, and Spain) to e... more A survey was performed in 5 European countries (France, Germany, Italy, Portugal, and Spain) to estimate the prevalence of fibromyalgia (FM) in the general population. In each country, the London Fibromyalgia Epidemiological Study Screening Questionnaire (LFESSQ) was administered by telephone to a representative sample of the community over 15 years of age. A positive screen was defined as the following: (1) meeting the 4-pain criteria alone (LFESSQ-4), or (2) meeting both the 4-pain and the 2-fatigue criteria (LFESSQ-6). The questionnaire was also submitted to all outpatients referred to the 8 participating rheumatology clinics for 1 month. These patients were examined by a rheumatologist to confirm or exclude the FM diagnosis according to the 1990 American College of Rheumatology classification criteria. The prevalence of FM in the general population was estimated by applying the positive-predictive values to eligible community subjects (ie, positive screens). Among rheumatology outpatients, 46% screened positive for chronic widespread pain (LFESSQ-4), 32% for pain and fatigue (LFESSQ-6), and 14% were confirmed FM cases. In the whole general population, 13 and 6.7% screened positive for LFESSQ-4 and LFESSQ-6, respectively. 3The estimated overall prevalence of FM was 4.7% (95% CI: 4.0 to 5.3) and 2.9% (95% CI: 2.4 to 3.4), respectively, in the general population. The prevalence of FM was age- and sex-related and varied among countries. FM appears to be a common condition in these 5 European countries, even if data derived from the most specific criteria set (LFESSQ-6) are considered.

Pediatric Rheumatology, 2011

Digestive Diseases and Sciences, 1994

Esophageal motility was studied in 21patients with Sj6gren "s syndrome, and in 25 normal voluntee... more Esophageal motility was studied in 21patients with Sj6gren "s syndrome, and in 25 normal volunteers, in order to record the prevalence and type of esophageal motor abnormalities. Esophageal motor abnormalities were detected in seven of the 21 patients (33.3%). These esophageal abnormalities did not correlate with the presence of dysphagia, the extraglandular involvement, or the presence of autoantibodies.

Clinical Rheumatology, 2012

Primary biliary cirrhosis (PBC) is an autoimmune disease in which intrahepatic bile ducts are tar... more Primary biliary cirrhosis (PBC) is an autoimmune disease in which intrahepatic bile ducts are targeted by an immune-mediated injury. This disease tends to progress to fibrosis and cirrhosis with hepatic failure. The authors report a case of a 50-year-old rheumatoid arthritis (RA) patient, with erosions and seropositive for rheumatoid factor and anti-citrullinated peptide antibodies, with 18 years disease duration refractory to prednisolone and several disease-modifying antirheumatic drugs, either conventional or biological (adalimumab and etanercept). In April 2007, she started therapy with rituximab (RTX) with good European League Against Rheumatism response achieved 9 months later. In June 2008, she was admitted with intrahepatic cholestasis, steatorrhea, and spontaneous fractures of various ribs. After excluding cholelitiasis, as well as infectious and neoplastic diseases a liver biopsy was performed that was compatible with the diagnosis of PBC. The antinuclear antibodies (1/160) were positive as well as the antimitochondrial antibodies (1/640). Other antibodies were negative such as anti-SSA and anti-SSB. Afterwards, the patient started ursodesoxycholic acid 15 mg kg-1 day-1 with progressive improvement of cholestatic markers. A labial salivary gland biopsy was performed and showed findings compatible with the concomitant diagnosis of Sjögren's syndrome. Based on this clinical report, a detailed review of the clinical aspects of PBC is presented as well as its association with other immune-mediated inflammatory diseases, particularly, with RA.

Annals of the Rheumatic Diseases, 2014

ABSTRACT Synovial biopsies have been collected by rheumatologists for several decades using arthr... more ABSTRACT Synovial biopsies have been collected by rheumatologists for several decades using arthroscopic guidance with the additional advantages of joint visualization and lavage. We aim to analyse the outcomes of the first 20 knee arthroscopic guided synovial biopsies (AGB) recently performed at our centre for diagnosis and (non-orthopedic) therapeutic purposes. AGB were performed according to standardised procedures. Nineteen were done for diagnostic purposes to patients with knee arthritis of unknown etiology, after application of a clinical algorithm. The remaining patient had a therapeutic indication. A macroscopic scoring for vascularization and proliferation was applied and synovial tissue processed for routine histology and microbiology assessment. 20 patients were submitted to AGB. Eight had a previous diagnosis of inflammatory arthritis: RA (2), JIA (2), PsA (3) and SLE (1). In all cases, patients were in joint remission with the exception of knee arthritis, raising the suspicion of undercurrent septic arthritis AGB allowed the exclusion of joint infection in 7 of 8 patients and septic arthritis was the established diagnosis in one case. This favoured rapid systemic therapeutic adjustment and/or intra-articular corticosteroids administration to induce remission, in non-infectious cases. In a PsA DMARD treated patient, direct visualization of crystal deposits on synovial membrane supported the diagnosis of concomitant crystal induced arthritis. The remaining patients had no previous rheumatic disease and presented with monoarthritis (7) or oligoarthritis (5) of unknown etiology. Considering the monoarthritis group, Mycobacterium tuberculosis was isolated in two patients. For the remaining five, infection was excluded and a definite diagnosis of osteoarthritis (1), crystal induced arthritis (3) and psoriatic arthritis (1) was established. In the oligoarthritis group, neither synovial membrane macroscopic, histology nor microbiology analysis helped to clarify the diagnosis. In inflammatory arthritis, persistent synovitis of a single joint can be a red flag for joint infection, however, in this small series, the majority of patients exhibited uncontrolled disease activity rather than septic arthritis. The rate of joint tuberculosis was particularly high (10%) highlighting its endemic occurrence in Portugal and awareness for this etiology. The visualization of crystal deposits can be a complementary diagnostic tool in patients with crystal induced arthritis in which crystals are not identified in the synovial fluid. Despite application of commonly available synovial tissue study strategies (macroscopy, histology and microbiology) in 25% of patients it was not possible to establish a definite diagnosis indicating that further synovial tissue biomarkers for inflammatory arthritis diagnosis are required.

Value in Health, 2008

OBJECTIVES: Fibromyalgia syndrome (FM) is an under diagnosed disorder of unknown etiology estimat... more OBJECTIVES: Fibromyalgia syndrome (FM) is an under diagnosed disorder of unknown etiology estimated between 0.5% and 5% in the general population. There is relatively little recent data on the epidemiology of FM worldwide , and specifically in Europe. The aim was to estimate the prevalence of Fibromyalgia Syndrome (FM) in clinical setting and in general population, in five European countries with the same methodology, METHODS: All patients addressed to the eight participating outpatient rheumatology clinics in a month were interviewed using the London Fibromyalgia Epidemiological Study Screening Questionnaire adding two questions on fatigue. The diagnosis of FM was confirmed using American College of Rheumatology classification criteria. The questionnaire was also administered by phone to a representative community sample more than 15 years old, selected by the quota method, in each country. The prevalence of FM was estimated in the general population, applying the predictive positive value in consultation, to the positive screens, RESULTS: A total of 46% of patients seen in rheumatology outpatients clinics were found positive for chronic widespread pain, 31.9% for widespread pain and fatigue. A total of 6.2% [15.9-16.4] were confirmed to be FM. In the general population, 13.3% were found positive for widespread pain and 6.7 % for widespread pain and fatigue. The FM prevalence in the general population, was 4.7% [4.0-5.3], when patients screened positive for chronic widespread pain were considered. If fatigue is added, the prevalence was 2.9% [2.4-3.4]. FM patients had a mean age of 54 years old (SD:12.5) and 94.1% of them where females. These last have a greater risk (5.2 [2.6-10.3]) of having FM. Likewise prevalence rises with age until 75-84 years, CONCLUSIONS: The FM prevalence, similar to that observed in Canada and United States, represents 6 million sufferers in the five European countries studied.