Filipa Oliveira-Ramos - Academia.edu (original) (raw)

Papers by Filipa Oliveira-Ramos

Journal of Multidisciplinary Healthcare

Non-infectious uveitis (NIU) is a group of sight-threatening diseases that generates significant ... more Non-infectious uveitis (NIU) is a group of sight-threatening diseases that generates significant burden for the healthcare systems due to its adverse outcomes, irreversible structural complications in the eye with loss of visual function, limited clinical expertise and low-grade evidence for best practice. The usefulness of multidisciplinary care, specifically close collaboration between Rheumatologists and Ophthalmologists in NIU, has been emphasized in the literature. In this paper, the assessment tools and protocols used in our clinic are depicted and an overview of our activity with a brief description of the patients included in our registry, between 2018 and 2020 is provided. The cohort of 290 patients assessed in our NIU clinic, their demographics, sources of referral, details about immunosuppression treatment, and internal and external collaborations is described. This experiencebased manuscript aims to describe the general functioning of our multidisciplinary NIU clinic, highlighting the benefits and drawbacks of multidisciplinary team management in patients with NIU, ultimately initiating a dialogue on what an NIU clinic should be and providing information for newly NIU clinics start-up. In conclusion, establishing a standardized and multidisciplinary clinic in NIU allows to systematically observe and follow-up this infrequent disease at a tertiary hospital level, thus improving quality of care delivery and research avenues.

Acta Reumatológica Portuguesa, 2019

Lupus enteritis (LE) is a rare, potentially life-threatening manifestation of systemic lupus eryt... more Lupus enteritis (LE) is a rare, potentially life-threatening manifestation of systemic lupus erythematosus (SLE). Early diagnosis is crucial for early treatment and prevention of serious complications such as ischemic enteritis, bowel infarction with bleeding and/or perforation and peritonitis. The objective of this case review is to identify strategies for early diagnosis of LE.

Acta Reumatologica Portuguesa, 2018

Frequency and risk factor analyses of bone erosion of the distal interphalangeal joint in patient... more Frequency and risk factor analyses of bone erosion of the distal interphalangeal joint in patients 239 with rheumatoid arthritis: a cross-sectional study Ikemura S, Hagio S, Akasaki Y, Fujiwara T, Tsushima H, Nakashima Y Obesity and diabetes are associated with disability in women with hand osteoarthritis. 208 Results from the EpiReumaPt nationwide study Cruz M, Rodrigues AM, Dias S, Sepriano A, Canhão H, Gouveia N, Ramiro S, Branco JC

Acta reumatologica portuguesa, 2019

The transition from paediatric to adult health care has been recognised as a priority in recent y... more The transition from paediatric to adult health care has been recognised as a priority in recent years. Health care transition (HCT) is defined as the process of moving from a paediatric to an adult model of health care with or without a transfer of follow up to a different clinician. In our centre, the transition begins around 11 years, when the patient education process starts and at the same time enable adolescents and young adults (AYA) to acquire knowledge to manage their disease. By the age of 18 the transfer to adult care is made. This study aims to evaluate the transition process and the transfer from paediatric to adult rheumatology care at our centre. We included 126 patients, 78 (61%) were female, with a mean age of 23.1±3.2 years. 104 patients (83%) were transferred to a young adult clinic. In our centre, the transition of care was associated with a high degree of satisfaction, with just a 10% decrease in patient satisfaction between paediatric and adult care. We had low ...

Acta reumatologica portuguesa, 2021

OBJECTIVE To investigate the relationship between body mass index (BMI) and disease activity in p... more OBJECTIVE To investigate the relationship between body mass index (BMI) and disease activity in patients with Juvenile Idiopathic Arthritis (JIA). METHODS Patients with JIA, aged ≤18 years, registered at the Rheumatic Diseases Portuguese Register (Reuma.pt) in Portugal and Brazil were included. Age- and sex-specific BMI percentiles were calculated based on WHO growth standard charts and categorized into underweight (P <3), normal weight (3≤P≤85), overweight (85 97). Disease activity was assessed by Juvenile Arthritis Disease Activity Score (JADAS-27). Uni- and multivariate analyses were performed. RESULTS A total of 275 patients were included. The prevalence of underweight, normal weight, overweight and obesity was 6.9%, 67.3%, 15.3% and 10.5%, respectively. Underweight patients had significantly higher number of active joints (p <0.001), patient's/parent's global assessment of disease activity (PGA) (p=0.020), physician's global assessment of disease activity (PhG...

Annals of the Rheumatic Diseases, 2020

Methotrexate (MTX) is the most widely used conventional synthetic disease-modifying antirheumatic... more Methotrexate (MTX) is the most widely used conventional synthetic disease-modifying antirheumatic drug (csDMARD) in the treatment of juvenile idiopathic arthritis (JIA).1,2When remission is achieved, questions remain about discontinuing MTX. There is some evidence that a longer period of inactive disease before MTX withdrawal is associated with lower likelihood of relapse, while both rheumatoid factor (RF) positive polyarthritis and extended oligoarthritis categories are associated with higher probability of disease relapse.2,3To identify predictive factors of relapse after discontinuation of MTX in JIA patients with inactive disease.Prospective multicentre cohort study in patients diagnosed with JIA, according to the ILAR classification, using real world data from the Portuguese national register database, Reuma.pt (Fig 1).4We evaluated patients who have reached JADAS27 inactive disease (≤1 and no active extra-articular manifestations) and discontinued MTX before the age of 18 year...

SBR 2021 Congresso Brasileiro de Reumatologia, 2021

BACKGROUND Rheumatic diseases are associated with an increase in overall risks of tuberculosis (T... more BACKGROUND Rheumatic diseases are associated with an increase in overall risks of tuberculosis (TB). The aim of this study was to evaluate the prevalence of TB and the value of screening latent TB infection (LTBI), in clinical practice for juvenile idiopathic arthritis (JIA) patients from high and low TB incidence endemic countries.

ObjectivesTo describe our experience with a coronavirus disease 2019 (COVID-19) outbreak within a... more ObjectivesTo describe our experience with a coronavirus disease 2019 (COVID-19) outbreak within a large rheumatology department, early in the pandemic.MethodsSymptomatic and asymptomatic healthcare workers (HCWs) had a naso-oropharyngeal swab for detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and were followed clinically. Reverse transcription polymerase-chain reaction (RT-PCR) was repeated to document cure, and serological response was assessed. Patients with risk contacts within the department in the 14 days preceding the outbreak were screened for COVID-19 symptoms.Results14/34 HCWs (41%; 40±14 years, 71% female) tested positive for SARS-CoV-2, and 11/34 (32%) developed symptoms but were RT-PCR-negative. Half of RT-PCR-positive HCWs did not report fever, cough, or dyspnoea before testing, which were absent in 3/14 cases (21%). Mild disease prevailed (79%), but 3 HCWs had moderate disease requiring further assessment, which excluded severe complications....

Lupus, 2020

Cardiac involvement in systemic lupus erythematosus (SLE) is well documented. The pericardium, my... more Cardiac involvement in systemic lupus erythematosus (SLE) is well documented. The pericardium, myocardium and endocardium, as well as the coronary arteries, the valves and the conduction system can all be affected. While pericarditis is common, arrythmias are less frequently described. We present a 13-year-old male, who had fatigue, anorexia, weight loss, myalgias and arthralgias for four months. On physical examination, we identified bradycardia (heart rate 31–50 bpm), oral and nasal ulcers and polyarthritis. The laboratory results showed hemolytic anemia, hypocomplementemia, antinuclear and anti-dsDNA antibodies, hematuria and non-nephrotic proteinuria. Renal function was normal. Lupus nephritis class II was diagnosed by kidney biopsy. On the transthoracic echocardiogram we identified a minimal pericardial effusion, suggesting pericarditis, and, on the electrocardiogram, we detected sinus arrest with junctional rhythm, denoting sinus node dysfunction. The patient was diagnosed wit...

RMD Open, 2020

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 novelstatus quoand 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 pending....

Abstracts Accepted for Publication, 2019

age, latin ethnicity and sedentary lifestyle were the RF related to the BMD of the whole body wit... more age, latin ethnicity and sedentary lifestyle were the RF related to the BMD of the whole body without head (BMDwbwh) In lumbar BMD, these 4 FR explained up to 85% of the BMD variation, where the age adds 0'032 per year gained, the male sex subtracts 0'061, the hypovitaminosis D sum 0'077 and the latin ethnicity subtracts 0'070 Up to a 90'8% variation of BMDwbwh is explained by these 3 RF: age adds 0'036 per year gained, sedentary life subtracts 0'084 and latin ethnicity subtracts 0'055. Conclusion: The child population at risk of LBM/IOp associates 2 or more risk factors 8.7% of children with risk factors have LBM and 4.8% IOP The RFs related to changes in BMD are: age, sex, sedentary lifestyle and ethnicity. Hypovitaminosis D correlated positively with lumbar BMD

Saturday, 15 June 2019, 2019

$Research paper thumbnail of Severe and Refractory Polyarteritis Nodosa Associated With CECR1 Mutation and Dramatic Response to Infliximab in Adulthood$

Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases, Jan 18, 2018

FIGURE. Magnetic resonance imaging scan of the brain showing acute ischemic stroke of the right l... more FIGURE. Magnetic resonance imaging scan of the brain showing acute ischemic stroke of the right lateral thalamus (A) and the left anterior corona radiata (B) on axial views (arrows).

Rheumatology international, 2018

The Juvenile Arthritis Multidimensional Assessment Report (JAMAR) is a new parent/patient reporte... more The Juvenile Arthritis Multidimensional Assessment Report (JAMAR) is a new parent/patient reported outcome measure that enables a thorough assessment of the disease status in children with juvenile idiopathic arthritis (JIA). We report the results of the cross-cultural adaptation and validation of the parent and patient versions of the JAMAR in the Portuguese language. The reading comprehension of the questionnaire was tested in 10 JIA parents and patients. Each participating centre was asked to collect demographic, clinical data and the JAMAR in 100 consecutive JIA patients or all consecutive patients seen in a 6-month period and to administer the JAMAR to 100 healthy children and their parents. The statistical validation phase explored descriptive statistics and the psychometric issues of the JAMAR: the three Likert assumptions, floor/ceiling effects, internal consistency, Cronbach's alpha, interscale correlations, and construct validity (convergent and discriminant validity)....

Acta reumatologica portuguesa

Patient registries are key instruments aimed at a better understanding of the natural history of ... more Patient registries are key instruments aimed at a better understanding of the natural history of diseases, at assessing the effectiveness of therapeutic interventions, as well as identifying rare events or outcomes that are not captured in clinical trials. However, the potential of registries goes far beyond these aspects. For example, registries promote the standardization of clinical practice, can also provide information on domains that are not routinely collected in clinical practice and can support decision-making. Being aware of the importance of registries, the Portuguese Society of Rheumatology developed the Rheumatic Diseases Portuguese Register- Reuma.pt - which proved to be an innovative instrument essential to a better understanding of systemic immune-mediated rheumatic diseases. To describe the contribution of Reuma.pt to the knowledge of systemic immune-mediated rheumatic diseases. Reuma.pt is widely implemented, with 77 centres actively contributing to the recruitment...

Pediatric Rheumatology, 2017

Introduction: In 2015 the historic Jones criteria for the diagnosis of Acute Rheumatic Fever (ARF... more Introduction: In 2015 the historic Jones criteria for the diagnosis of Acute Rheumatic Fever (ARF) were revised introducing two different sets of criteria for low-risk and for moderate/high-risk populations (according to ARF incidence). In Italy the exact ARF incidence is unknown but small regional or local reports suggest an incidence of 2-5/100.000 per year, suggesting that our population might be considered at moderate risk for ARF. Objectives: To evaluate the performance of the revised Jones criteria in a retrospective population and to compare it with the performance of the previous version of Jones criteria. Methods: We conducted a retrospective study on 288 patients with ARF (108 female; median age 8.5 years, IQR 7.1-10.3) diagnosed from 2001 to 2015 in a Pediatric Rheumatology Division by pediatric rheumatologists, discharged with an ICD 9 code consistent with ARF. We retrospectively applied the two sets (for low-risk and for moderate/high-risk) of the 2015 revised Jones criteria and the 1992 version of the Jones criteria. Results: Of 288 patients, 253 (87.8%) met the 1992 version of the Jones criteria, 237 (82.3%) met the revised criteria for low-risk populations and 259 (89.9%) for moderate/high-risk populations. None of these differences was significant. Prevalence of major and minor criteria is shown in Table. With the exception of difference in arthritis, the 1992 version and the 2015 revised version did not show major differences. Of the 288 patients with a clinical diagnosis of ARF 29 did not meet any version of the Jones criteria. Patients in this group presented with isolated chorea or silent carditis without other manifestations. Prevalence of the clinical characteristics and comparison among the 1992 version of Jones criteria and the 2015 revised Jones criteria (low risk and moderate-high risk populations): Values are expressed in Number (percentage). *p value (Fisher Exact test) Conclusion: The revised Jones criteria for low-risk populations are slightly more sensitive than the 1992 version of Jones criteria, while the revised Jones criteria for moderate/high populations are slightly less sensitive than the 1992 version. In this population, the revised criteria did not substantially modify the diagnosis of ARF. Approximately 10% of patients presented with isolated chorea or silent carditis.

Oral Presentations, 2017

Background: Persistence on medication mainly reflects both effectiveness and safety of a drug. Un... more Background: Persistence on medication mainly reflects both effectiveness and safety of a drug. Understanding the reasons to stop bDMARD in routine clinical practice can help to better define the efficacy and safety of biologic medications in children with juvenile idiopathic arthritis (JIA). Objectives: To investigate persistence on treatment and the reasons for discontinuation of the first biological in patients with JIA. Methods: Portuguese patients with JIA registered in Reuma.pt who started a bDMARD were analyzed. Persistence was defined as the time between treatment initiation and discontinuation of the first bDMARD. The mean time until discontinuation was calculated using Cox regression survival estimates and the reasons for discontinuation of the first bDMARD were registered. Results: Of the 1724 JIA patients registered in Reuma.pt, 319 received biological therapy, 62% (198) female. The mean age at disease onset was 7.7±4.8 years and the mean time between the beginning of JIA and the first bDMARD was 8.2±9.4 years. The mean disease duration was 13.7±10.7 years and the mean age at the beginning of biological therapy was 15.8±9.4 years. The distribution of JIA subtypes was: 19.1% polyarticular RF-negative, 17.2% enthesitis-related arthritis, 16.6% polyarticular RF-positive, 16% extended oligoarticular, 13.5% persistent oligoarticular, 12% systemic JIA and 0.9% had undifferentiated arthritis. Considering the whole group, 53.2% have had extra-articular manifestations and 18.4% have or had had uveitis since the beginning of the disease. Persistence on treatment, before discontinuation (due to any cause) was 34.7 months (range: 0.03-182 months) adjusted for gender, biological therapy, JIA subtype, age at the beginning of biological therapy, and disease duration until initiating first bDMARD. The major reasons for drug discontinuation was inefficacy (49.6%), remission (14.2%), adverse events (10.6%), patient decision (1.6%) and pregnancy planning (1.4%). In 22.7% the reason was not specified. Conclusions: Almost half of the JIA patients stop the first biological agent, due to lack of response, reinforcing the need for the existence of several treatment options fully studied in JIA.

Rheumatology (Oxford, England), Jan 15, 2015

Assess the effectiveness and safety of biologic therapy as well as predictors of response at 1 ye... more Assess the effectiveness and safety of biologic therapy as well as predictors of response at 1 year of therapy, retention rate in biologic treatment and predictors of drug discontinuation in JIA patients in the Portuguese register of rheumatic diseases. We prospectively collected patient and disease characteristics from patients with JIA who started biological therapy. Adverse events were collected during the follow-up period. Predictors of response at 1 year and drug retention rates were assessed at 4 years of treatment for the first biologic agent. A total of 812 JIA patients [65% females, mean age at JIA onset 6.9 years (s.d. 4.7)], 227 received biologic therapy; 205 patients (90.3%) were treated with an anti-TNF as the first biologic. All the parameters used to evaluate disease activity, namely number of active joints, ESR and Childhood HAQ/HAQ, decreased significantly at 6 months and 1 year of treatment. The mean reduction in Juvenile Disease Activity Score 10 (JADAS10) after 1...

Journal of Immunology Research, 2015

Introduction.This study aimed to assess the genetic determinants of poor outcome in Portuguese pa... more Introduction.This study aimed to assess the genetic determinants of poor outcome in Portuguese patients with juvenile idiopathic arthritis (JIA).Methods.Our study was conducted in Reuma.pt, the Rheumatic Diseases Portuguese Register, which includes patients with JIA. We collected prospectively patient and disease characteristics and a blood sample for DNA analysis. Poor prognosis was defined as CHAQ/HAQ >0.75 at the last visit and/or the treatment with biological therapy. A selected panel of single nucleotide polymorphisms (SNPs) associated with susceptibility was studied to verify if there was association with poor prognosis.Results.Of the 812 patients with JIA registered in Reuma.pt, 267 had a blood sample and registered information used to define “poor prognosis.” In univariate analysis, we found significant associations with poor prognosis for allele A ofTNFA1P3/20rs6920220, allele G ofTRAF1/C5rs3761847, and allele G ofPTPN2rs7234029. In multivariate models, the associations ...