Marcia Midori Shinzato - Academia.edu (original) (raw)

Papers by Marcia Midori Shinzato

Acta Scientiarum. Health Science, Nov 9, 2023

This study analyzed the joint pain of 46 patients with rheumatoid arthritis (RA) undergoing treat... more This study analyzed the joint pain of 46 patients with rheumatoid arthritis (RA) undergoing treatment with disease-modifying antirheumatic drugs (DMARD), for at least one year, and evaluated by pain intensity numeric scale and by the McGill Pain Questionnaire (MPQ), anxiety and depression by the Hospital Anxiety and Depression Scale (HADS). We compared them with 46 patients without RA matched by age and sex. We also examined the relationships between anxiety and depression and pain intensity, disease activity and physical dysfunction accessed by the Rheumatoid Arthritis Disease Activity Index (RADAI) and the Health Assessment Questionnaire (HAQ), respectively. Most patients with RA, 93.5%, continued to report joint pain and had higher pain intensity and higher scores in all domains of the McGill Pain Questionnaire (MPQ) than 58.7% of the 46patients without RA with joint pain. Patients with RA were more likely to have depression defined by HADS≥11 than the controls but the association was non-significant when adjusted for the presence of pain. The median score of anxiety symptoms was significantly higher in patients with RA than in those without RA. There was an association of depression and a positive significant correlation of anxiety symptoms with higher intensity of pain, disease activity and physical dysfunction. There was no difference between patients with RA and depression and without depression on the sensory domain and in the total MPQ score. Otherwise, there was a moderate significant correlation of the levels of anxiety with all pain domains of the MPQ, except the sensory one. In conclusion, pain remains a prevalent symptom in RA patients despite treatment. More studies are necessary to verify if the qualitative assessment of pain could be used to evaluate the influence of anxiety and depression on pain reported by these patients.

BACKGROUND Knee osteoarthritis reduces physical function increasing the risk of developing other ... more BACKGROUND Knee osteoarthritis reduces physical function increasing the risk of developing other chronic conditions. We aimed to estimate the prevalence of symptomatic knee osteoarthritis (KOA) not related to trauma in a rural community in Brazil and to study the relationship between age, gender, body mass index (BMI), abdominal obesity and the most frequent self-assessed chronic diseases with KOA. MATERIALS AND METHODS This was a cross-sectional study in which randomly selected individuals over 15 years old from a rural community were administered a structure questionnaire to collect demographic data and self-reported chronic diseases. We carried out standardized measurement of patients' height, weight and waist circumference. Body mass index were categorized as normal (< 25 kg/m2) and overweight/obesity (≥ 25 kg/m2). Abdominal obesity was defined as waist circumference ≥ 94 cm for men and ≥ 80 cm for women. Participants were classified as having knee OA if they fulfilled the American College of Rheumatology (ACR) clinical criteria for knee OA1. Student t or qui-squared tests were used to compare those with and without knee OA. Significant (two-tailed p < 0.05) variables were chosen for multivariate analysis by logistic regression, one model with BMI and another one with abdominal obesity. The ethics committee from Universidade Federal da Grande Dourados approved the study (CAAE: 69543517.6.0000.5160) and all participants signed an informed consent for participation. RESULTS We included 372 people, 212 (57%) women with a mean age of 46.5 (18.3) years. Prevalence of symptomatic KOA not related to trauma was 14.52% (95% CI = 11.3-18.46). People with KOA were older (57.70 ± 14.46 vs. 46.66 ± 18.23 years old, p < 0.0001) more likely to be women (77.78 vs. 53.46%, p = 0.001). They also have higher frequency of hypertension (50 vs. 26.41%, p = 0.001), type 2 diabetes (33.33 vs. 8.18%, p < 0.0001), dyslipidaemia (27.78 vs. 11.78%, p = 0.009), anxiety/depression (38.89 vs. 14.46%, p < 0.0001), overweight/obesity (83.33 vs. 61%, p = 0.003) and abdominal obesity (92.59 vs. 61.63%, p < 0.0001). Multivariate analysis showed that KOA were significantly associated with age (odds ratio,

Revista brasileira de reumatologia, Nov 1, 2015

Purpose of review To highlight recent evidence regarding the contribution of traditional and nont... more Purpose of review To highlight recent evidence regarding the contribution of traditional and nontraditional [e.g. inflammatory markers, rheumatoid arthritis (RA) features] risk factors toward the excess cardiovascular risk in RA. Recent findings The impact of traditional risk factors on the development of cardiovascular disease in persons with RA is an area of active research. Some are more prevalent among people with RA (e.g. smoking); others appear to have paradoxical relationships (e.g. body mass index), and findings remain inconsistent with others (e.g. dyslipidemia). Collectively the data suggest that cardiovascular risk factors behave differently in RA. Thus, risk scores developed for the general population based on traditional cardiovascular risk factors alone are unlikely to accurately estimate cardiovascular risk in RA, highlighting the need for RA-specific risk prediction tools. Nontraditional risk factors, in particular RA disease activity/severity measures, including inflammatory markers, disease activity scores, seropositivity, physical disability, destructive changes on joint radiographs, extra-articular manifestations, and corticosteroid use, have repeatedly shown significant associations with increased cardiovascular risk. Medications used to treat RA may also affect cardiovascular risk. A recent meta-analysis suggests that all nonsteroidal anti-inflammatory drugs confer some cardiovascular risk. The cardiovascular risks/benefits associated with use of disease-modifying antirheumatic drugs and/or biologics remain controversial, as does the role of statins in RA. Summary Cardiovascular disease remains a major problem for people with RA. Future work should focus on further delineating the underlying biological mechanisms involved, developing and evaluating risk assessment tools and biomarkers, as well as prevention/treatment strategies specific to the RA population.

Lupus, Dec 1, 2005

We have analysed in vitro the complement-fixing activity of anticardiolipin antibodies (C-fix aCL... more We have analysed in vitro the complement-fixing activity of anticardiolipin antibodies (C-fix aCL) from patients with persistent and moderate/high titres IgG aCL antibodies: 21 with thrombosis and 11 without thrombosis. Titre and C-fix ability of aCL were measured by ELISA. APS and non-APS patients were similar with regard to mean levels of IgG aCL (46 ± 24 versus 51 ± 30 GPL, P = 0.7), frequency of IgM aCL ( P = 0.7) and a comparable predominance of IgG2 aCL reactivity on ELISA (95% versus 100%, respectively, P = 1.0 ). Remarkably, a high frequency of C-fix aCL (71% versus 92%, P = 0.35) was observed in both groups. Similarly, no difference was observed in the mean level of C-fix aCL in APS and non-APS patients (7 ± 6 versus 9 ± 8 SDunits, P = 0.3). Analysis of 10 primary and 11 secondary APS also revealed a comparable IgG aCL mean titre (57 ± 29 versus 37 ± 11, P = 0.06), frequency of IgM aCL ( P = 0.6) and of C-fix aCL (70% versus 73%, P = 0.99). Among APS patients six had exclusive arterial events and seven exclusive venous events. The IgG aCL mean titre (36 ± 10 versus 36 ± 11 GPL, P = 0.9) and the frequency of IgM aCL antibodies ( P = 0.56) in these subgroups of patients were comparable. There was a trend of higher frequency of C-fix aCL in patients with exclusive venous events (100%) compared to 50% of those with exclusive arterial events (p = 0.07). Importantly, C-fix aCL titre was higher in the former group compared to the later one (8 ± 5 SDunits versus 2 ± 2 SDunits, P = 0.016). Our data support the notion of a high frequency of C-fix aCL in APS. Although it does not discriminate those patients without thrombotic events with persistent moderate/high levels of aCL, this property seems to be more relevant in venous events and may provide the basis for further understanding the distinct pathogenic mechanisms underlying arterial and venous occlusive disorders of APS.

Postgraduate Medical Journal, Nov 1, 1999

We report the case of a 40-year-old women with diVuse uveitis, sensorineural hearing loss and cer... more We report the case of a 40-year-old women with diVuse uveitis, sensorineural hearing loss and cerebrospinal fluid pleocytosis as features of Vogt-Koyanagi-Harada syndrome who developed symmetric polyarthritis and stiVness of small and large joints, in addition to rheumatoid arthritis. Although their target tissues are distinct, both diseases have a possible autoimmune origin strongly associated with HLA-DRB4.

Revista Brasileira De Reumatologia, Nov 1, 2015

Material and methods: A descriptive cross-sectional study with 71 patients with established RA. T... more Material and methods: A descriptive cross-sectional study with 71 patients with established RA. The instruments used were: DAS-28, HAQ and SF-36, and the following parameters were determined: the erythrocyte sedimentation rate, capillary blood glucose; total cholesterol (TC) and its fractions, thyroid hormones, antinuclear antibodies (ANA), rheumatoid factor (RF) and antibodies against citrullinated proteins (ACPAs). Patients were classified into groups HAQ ≤ 1 (mild dysfunction) and HAQ > 1 (moderate and severe dysfunction) and, according to the HAQ scores, in groups treated with corticosteroids (CS) and without CS. Results: 9 patients were male and 62 female with mean age and duration of disease of 53.45 (±10.7) and 9.9 (±8.6), respectively. RF was positive in 52 (76%), ACPAs in 54 (76.1%) and ANA in 12 (16.9%). Thirty-six patients (50.7%) had systemic hypertension, 9 (12.68%) diabetes mellitus, 16 (22.5%) hypothyroidism, 33 (46.5%) dyslipidemia and 8 (11.27%) were smokers. The results of TC > 240 were found in 53.8% for group HAQ > 1 (26) and in 24.4% for group HAQ ≤ 1 (45) (p = 0.020). These groups did not differ as to presence of comorbidities or drug treatment. Triglyceride levels >200 for the group with CS (42.4%) versus without CS (18.42%) were significant (p = 0.025). Conclusion: An association of increased TC and triglycerides with results of HAQ ≤ 1 and with CS use was noted, reinforcing the importance of screening risk factors associated with cardiovascular disease in RA.

Even3 Publicações eBooks, 2023

Revista Brasileira de Reumatologia, 2012

Glucocorticoids (GC) are used in almost all medical specialties, and approximately 0.5% of the ge... more Glucocorticoids (GC) are used in almost all medical specialties, and approximately 0.5% of the general population of the United Kingdom receives those medications. With the increased survival of patients with rheumatological diseases, morbidity secondary to the use of those medications represents an important aspect of the management of our patients. The incidences of vertebral and non-vertebral fractures are elevated, ranging from 30% to 50% of the individuals on GC for over three months. Thus, osteoporosis and frailty fractures should be prevented and treated in all patients initiating or already on GC. There are several recommendations on this topic elaborated by several international societies, but consensus still lacks. Recently, the American College of Rheumatology has published new recommendations, but they are based on the WHO Fracture Risk Assessment Tool (FRAX®) to evaluate the risk for each individual, and, thus, cannot be completely used for the Brazilian population. Thus, the Committee for Osteoporosis and Bone Metabolic Disorders of the Brazilian Society of Rheumatology, along with the Brazilian Medical Association and the Brazilian Association of Physical Medicine and Rehabilitation, has elaborated the Brazilian Guidelines for Glucocorticoid-Induced Osteoporosis (GIO), based on the better available scientifi c evidence and/or expert experience. Method of evidence collection: The bibliographic review of scientifi c articles of this guideline was performed in the MEDLINE database. The search for evidence was based on real clinical scenarios, and used the following keywords (MeSH terms

British Journal of Ophthalmology, May 1, 2003

Aniridia-associated cytogenetic rearrangements suggest that a position effect may cause the mutan... more Aniridia-associated cytogenetic rearrangements suggest that a position effect may cause the mutant phenotype. Hum Mol Genet 1995;4:415-22. 3 Nishimura DY, Swiderski RE, Alward WL, et al. The forkhead transcription factor gene FKHL7 is responsible for glaucoma phenotypes which map to 6p25. Nat Genet 1998;19:140-7. 4 Flomen RH, Vatcheva R, Gorman PA, et al. Construction and analysis of a sequence-ready map in 4q25: Rieger syndrome can be caused by haploinsufficiency of RIEG, but also by chromosome breaks approximately 90 kb upstream of this gene. Genomics 1998;47:409-13. 5 Gardner RJM, Sutherland GR. Chromosome abnormalities and genetic counselling.

Anais do Congresso Brasileiro de Reumatologia 2020, 2021

BACKGROUND Knee osteoarthritis reduces physical function increasing the risk of developing other ... more BACKGROUND Knee osteoarthritis reduces physical function increasing the risk of developing other chronic conditions. We aimed to estimate the prevalence of symptomatic knee osteoarthritis (KOA) not related to trauma in a rural community in Brazil and to study the relationship between age, gender, body mass index (BMI), abdominal obesity and the most frequent self-assessed chronic diseases with KOA. MATERIALS AND METHODS This was a cross-sectional study in which randomly selected individuals over 15 years old from a rural community were administered a structure questionnaire to collect demographic data and self-reported chronic diseases. We carried out standardized measurement of patients' height, weight and waist circumference. Body mass index were categorized as normal (< 25 kg/m2) and overweight/obesity (≥ 25 kg/m2). Abdominal obesity was defined as waist circumference ≥ 94 cm for men and ≥ 80 cm for women. Participants were classified as having knee OA if they fulfilled the American College of Rheumatology (ACR) clinical criteria for knee OA1. Student t or qui-squared tests were used to compare those with and without knee OA. Significant (two-tailed p < 0.05) variables were chosen for multivariate analysis by logistic regression, one model with BMI and another one with abdominal obesity. The ethics committee from Universidade Federal da Grande Dourados approved the study (CAAE: 69543517.6.0000.5160) and all participants signed an informed consent for participation. RESULTS We included 372 people, 212 (57%) women with a mean age of 46.5 (18.3) years. Prevalence of symptomatic KOA not related to trauma was 14.52% (95% CI = 11.3-18.46). People with KOA were older (57.70 ± 14.46 vs. 46.66 ± 18.23 years old, p < 0.0001) more likely to be women (77.78 vs. 53.46%, p = 0.001). They also have higher frequency of hypertension (50 vs. 26.41%, p = 0.001), type 2 diabetes (33.33 vs. 8.18%, p < 0.0001), dyslipidaemia (27.78 vs. 11.78%, p = 0.009), anxiety/depression (38.89 vs. 14.46%, p < 0.0001), overweight/obesity (83.33 vs. 61%, p = 0.003) and abdominal obesity (92.59 vs. 61.63%, p < 0.0001). Multivariate analysis showed that KOA were significantly associated with age (odds ratio,

Anais do Congresso Brasileiro de Reumatologia 2020, 2021

BACKGROUND Musculoskeletal diseases can worsen metabolic syndrome (MetS) as patients develop sede... more BACKGROUND Musculoskeletal diseases can worsen metabolic syndrome (MetS) as patients develop sedentary behaviors leading to loss of muscle which can damage other musculoskeletal structures. Therefore, we aimed to study musculoskeletal diseases in patients with MetS by comparing clinical and laboratory features between groups with and without MetS. MATERIALS AND METHODS This case-control study included 64 and 42 individuals with and without MetS, respectively, with similar age, and sex distribution recruited between June 2018 and September 2019. They underwent medical evaluation for the diagnosis of musculoskeletal disorders lasting more than 12 weeks and also to documented metabolic syndrome features. First univariate analysis was carried out for laboratory parameters, each musculoskeletal site and also for knee osteoarthritis, plantar fasciitis and fibromyalgia. Variables resulting significant or with marginal significance were selected for multivariate analysis by logistic regression. The ethics committee from UFGD approved the study (CAAE57333816.5.0000.5160) and all participants signed an informed consent for participation.

Blucher Medical Proceedings, 2019

Lupus, 2004

Sir—Vogt–Koyanagi–Harada (VKH) syndrome is an autoimmune disease targeted against pigmented tissu... more Sir—Vogt–Koyanagi–Harada (VKH) syndrome is an autoimmune disease targeted against pigmented tissues in a susceptible individual. It is characterized by a diffuse intraocular in ammation, in the absence of a previous ocular trauma, associated or not with central nervous system (CNS) and skin manifestations. Even though the cellular component of uvea inŽ ltration is mainly composed of CD4 T-cells, components of a humoral response, such as B-cells, complement and immunoglobulin depositions, are also found, suggesting that they may play a role in its pathogenesis. In the present study we analysed the presence of systemic autoantibodies in VKH syndrome as a model of tissue-speciŽ c autoimmune disease in which uveitis is the main feature. Sera samples from 23 patients with VKH, eight with Behçet’s disease (BD) and four with ankylosing spondylitis (AS), all with intraocular in ammation, were analysed. Sera from 20 normal controls were also tested. Detection of autoantibodies to anti-SS-A/Ro and anti-SS-B/La was performed by counter immunoelectrophoresis. Antinuclear (ANA), anti-double stranded (ds) DNA, anti-Sm, anti-RNP antibodies and rheumatoid factor (RF) were determined by standard processes. We slightly modiŽ ed the ELISA assay to detect anti-histone antibodies described by Monastier et al. 5 by the use of bovine gammaglobulin 0.1% in the diluents and blocking solutions. Four of 23 VKH patients (17%) had a positive immuno uorescence with Hep-2 cells. Two sera had a Ž ne nuclear speckled pattern, one a nuclear homogeneous and one a speckled cytoplasmatic. The Ž rst two sera were positive to anti-SS-A/Ro. Interestingly, neither of these patients has complaints of dry eyes or mouth and both have a normal tear function documented by Schirmer test and rose Bengal staining. In contrast, all sera from patients with BD and AS, as well as from normal controls, were uniformly negative. Similarly, no antibodies were detected against Sm, RNP, histone and dsDNA in any tested group. Two VKH patients were RF positive and both sera were negative to anti-SS-A/Ro. One of them had the rare association of VKH and rheumatoid arthritis. No association with active eye in ammation was observed in the ANA positive group. It may be relevant that all patients with active disease were under prednisone alone or in association with other immunosuppressive therapy. Concerning anti-SS-A/Ro antibodies, one of the patients was under prednisone therapy (10 mg/day). This is the Ž rst report of anti-SS-A/Ro antibodies in VKH syndrome. It is remarkable that the high frequency of 10% observed herein is almost 20 times greater than that described by Fritzler et al. 7 in 2500 blood donor women. Furthermore, the use of immunosuppressive therapy in almost half of our patients may have underestimated our results. Even though 80% of patients with anti-SS-A/Ro antibodies usually have rheumatoid factor, in the present data both patients positive for these antibodies and VKH neither had Sjögren syndrome or rheumatoid factor. It is described that some anti-SS-A/Ro antibodies have an intrinsic RF activity. In conclusion, we report for the Ž rst time the presence of these antibodies in sera from patients with VKH by a highly speciŽ c method. Its role in the pathogenesis of the disease should be further investigated since it has been demonstrated that its 60 kDa protein has a sequence homology with the carboxy-terminal sequence of calreticulin. High reactivity against calreticulin is described in onchocerciasis eye diseases. Interestingly, the histopathology of experimental studies in rabbits suggested that it started with a choroiditis and is followed by a secondary degeneration of the overlying pigment epithelium and neuroretin, Ž ndings partially similar to those found in VKH syndrome. Taken together, there are some similarities between VKH syndrome and ocular onchocerciasis regarding some aspects of ocular histopathological Ž ndings. Whether the diseases could have a shared target autoantigen will be the subject of further research.

British Journal of Ophthalmology, 2003

Aniridia-associated cytogenetic rearrangements suggest that a position effect may cause the mutan... more Aniridia-associated cytogenetic rearrangements suggest that a position effect may cause the mutant phenotype. Hum Mol Genet 1995;4:415-22. 3 Nishimura DY, Swiderski RE, Alward WL, et al. The forkhead transcription factor gene FKHL7 is responsible for glaucoma phenotypes which map to 6p25. Nat Genet 1998;19:140-7. 4 Flomen RH, Vatcheva R, Gorman PA, et al. Construction and analysis of a sequence-ready map in 4q25: Rieger syndrome can be caused by haploinsufficiency of RIEG, but also by chromosome breaks approximately 90 kb upstream of this gene. Genomics 1998;47:409-13. 5 Gardner RJM, Sutherland GR. Chromosome abnormalities and genetic counselling.

Clinical Rheumatology, 2016

It has been suggested that hearing impairment (HI) is one of the extra-articular features of rheu... more It has been suggested that hearing impairment (HI) is one of the extra-articular features of rheumatoid arthritis (RA). Nevertheless, the prevalence and nature of HI in RA is still uncertain. The objectives were to study hearing function in patients with RA using audiometric tests and to examine whether HI correlates with autoantibodies. Hearing functions were investigated in 43 consecutive RA patients and 23 control subjects (less than 60 years old). Their sera were evaluated for the presence of rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), and anti-mutated citrullinated vimentin (anti-MCV) antibodies. HI was observed in 46.5 % of RA patients and in 30.4 % of control subjects, p = 0.32. HI was characterized as sensorineural in 80 and 85.7 % of RA patients and control subjects with HI, respectively, p = 1.00. RA patients had a worse hearing threshold for air conduction at 6 kHz in the right ear (p = 0.019) and had a decreased amplitude of otoacoustic emissions (OAEs) at 2 kHz bilaterally (p = 0.04) compared with control subjects. In the RA group, patients with and without HI were 80 and 34.78 % anti-CCP positive, respectively, p = 0.008. RA patients with and without HI were 85 and 43.48 % anti-MCV positive, respectively, p = 0.013. HI in RA patients was mainly sensorineural and was associated with anti-CCP and anti-MCV antibodies.

Blucher Medical Proceedings, 2019

The Brazilian guidelines for prevention and treatment of glucocorticoid-induced osteoporosis were... more The Brazilian guidelines for prevention and treatment of glucocorticoid-induced osteoporosis were updated and important topics were included such as assessment of risk fracture using FRAX Brazil, use of denosumab, and also recommendations for the use of glucocorticoid pulse therapy and inhaled glucocortiocoid. Introduction Glucocorticoids (GCs) are used in almost all medical specialties and the incidences of vertebral/nonvertebral fractures range from 30 to 50% in individuals treated with GCs for over 3 months. Thus, osteoporosis and frailty fractures should be prevented and treated in patients initiating treatment or already being treated with GCs. The Committee for Osteoporosis and Bone Metabolic Disorders of the Brazilian Society of Rheumatology (BSR) established in 2012 the Brazilian Guidelines for glucocorticoid-induced osteoporosis (GIO). Herein, we provide a comprehensive update of the original guidelines based on improved available scientific evidence and/or expert experience. Methods From March to June 2020, the Osteoporosis Committee of the BRS had meetings to update the questions presented in the first consensus (2012). Thus, twenty-six questions considered essential for the preparation of the recommendations were selected. A systematic literature review based on real-life scenarios was undertaken to answer the proposed questions. The MEDLINE, EMBASE, and SCOPUS databases were searched using specific search keywords. Results Based on the review and expert opinion, the recommendations were updated for each of the 26 questions. We included 48 new bibliographic references that became available after the date of the publication of the first version of the consensus. Conclusion We updated the Brazilian guidelines for the prevention/treatment of GIO. New topics were added in this update, such as the assessment of risk fracture using FRAX Brazil, the use of denosumab, and approaches for the treatment of children and adolescents. Furthermore, we included recommendations for the use of inhaled GCs and GC pulse therapy in clinical settings.

Lupus, 2005

We have analysed in vitro the complement-fixing activity of anticardiolipin antibodies (C-fix aCL... more We have analysed in vitro the complement-fixing activity of anticardiolipin antibodies (C-fix aCL) from patients with persistent and moderate/high titres IgG aCL antibodies: 21 with thrombosis and 11 without thrombosis. Titre and C-fix ability of aCL were measured by ELISA. APS and non-APS patients were similar with regard to mean levels of IgG aCL (46 +/- 24 versus 51 +/- 30 GPL, P = 0.7), frequency of IgM aCL (P = 0.7) and a comparable predominance of IgG2 aCL reactivity on ELISA (95% versus 100%, respectively, P = 1.0). Remarkably, a high frequency of C-fix aCL (71% versus 92%, P = 0.35) was observed in both groups. Similarly, no difference was observed in the mean level of C-fix aCL in APS and non-APS patients (7 +/- 6 versus 9 +/- 8 SDunits, P = 0.3). Analysis of 10 primary and 11 secondary APS also revealed a comparable IgG aCL mean titre (57 +/- 29 versus 37 +/- 11, P = 0.06), frequency of IgM aCL (P = 0.6) and of C-fix aCL (70% versus 73%, P = 0.99). Among APS patients six had exclusive arterial events and seven exclusive venous events. The IgG aCL mean titre (36 +/- 10 versus 36 +/- 11 GPL, P = 0.9) and the frequency of IgM aCL antibodies (P = 0.56) in these subgroups of patients were comparable. There was a trend of higher frequency of C-fix aCL in patients with exclusive venous events (100%) compared to 50% of those with exclusive arterial events (p = 0.07). Importantly, C-fix aCL titre was higher in the former group compared to the later one (8 +/- 5 SDunits versus 2 +/- 2 SDunits, P = 0.016). Our data support the notion of a high frequency of C-fix aCL in APS. Although it does not discriminate those patients without thrombotic events with persistent moderate/high levels of aCL, this property seems to be more relevant in venous events and may provide the basis for further understanding the distinct pathogenic mechanisms underlying arterial and venous occlusive disorders of APS.

Acta Scientiarum. Health Science, Nov 9, 2023

This study analyzed the joint pain of 46 patients with rheumatoid arthritis (RA) undergoing treat... more This study analyzed the joint pain of 46 patients with rheumatoid arthritis (RA) undergoing treatment with disease-modifying antirheumatic drugs (DMARD), for at least one year, and evaluated by pain intensity numeric scale and by the McGill Pain Questionnaire (MPQ), anxiety and depression by the Hospital Anxiety and Depression Scale (HADS). We compared them with 46 patients without RA matched by age and sex. We also examined the relationships between anxiety and depression and pain intensity, disease activity and physical dysfunction accessed by the Rheumatoid Arthritis Disease Activity Index (RADAI) and the Health Assessment Questionnaire (HAQ), respectively. Most patients with RA, 93.5%, continued to report joint pain and had higher pain intensity and higher scores in all domains of the McGill Pain Questionnaire (MPQ) than 58.7% of the 46patients without RA with joint pain. Patients with RA were more likely to have depression defined by HADS≥11 than the controls but the association was non-significant when adjusted for the presence of pain. The median score of anxiety symptoms was significantly higher in patients with RA than in those without RA. There was an association of depression and a positive significant correlation of anxiety symptoms with higher intensity of pain, disease activity and physical dysfunction. There was no difference between patients with RA and depression and without depression on the sensory domain and in the total MPQ score. Otherwise, there was a moderate significant correlation of the levels of anxiety with all pain domains of the MPQ, except the sensory one. In conclusion, pain remains a prevalent symptom in RA patients despite treatment. More studies are necessary to verify if the qualitative assessment of pain could be used to evaluate the influence of anxiety and depression on pain reported by these patients.

BACKGROUND Knee osteoarthritis reduces physical function increasing the risk of developing other ... more BACKGROUND Knee osteoarthritis reduces physical function increasing the risk of developing other chronic conditions. We aimed to estimate the prevalence of symptomatic knee osteoarthritis (KOA) not related to trauma in a rural community in Brazil and to study the relationship between age, gender, body mass index (BMI), abdominal obesity and the most frequent self-assessed chronic diseases with KOA. MATERIALS AND METHODS This was a cross-sectional study in which randomly selected individuals over 15 years old from a rural community were administered a structure questionnaire to collect demographic data and self-reported chronic diseases. We carried out standardized measurement of patients' height, weight and waist circumference. Body mass index were categorized as normal (< 25 kg/m2) and overweight/obesity (≥ 25 kg/m2). Abdominal obesity was defined as waist circumference ≥ 94 cm for men and ≥ 80 cm for women. Participants were classified as having knee OA if they fulfilled the American College of Rheumatology (ACR) clinical criteria for knee OA1. Student t or qui-squared tests were used to compare those with and without knee OA. Significant (two-tailed p < 0.05) variables were chosen for multivariate analysis by logistic regression, one model with BMI and another one with abdominal obesity. The ethics committee from Universidade Federal da Grande Dourados approved the study (CAAE: 69543517.6.0000.5160) and all participants signed an informed consent for participation. RESULTS We included 372 people, 212 (57%) women with a mean age of 46.5 (18.3) years. Prevalence of symptomatic KOA not related to trauma was 14.52% (95% CI = 11.3-18.46). People with KOA were older (57.70 ± 14.46 vs. 46.66 ± 18.23 years old, p < 0.0001) more likely to be women (77.78 vs. 53.46%, p = 0.001). They also have higher frequency of hypertension (50 vs. 26.41%, p = 0.001), type 2 diabetes (33.33 vs. 8.18%, p < 0.0001), dyslipidaemia (27.78 vs. 11.78%, p = 0.009), anxiety/depression (38.89 vs. 14.46%, p < 0.0001), overweight/obesity (83.33 vs. 61%, p = 0.003) and abdominal obesity (92.59 vs. 61.63%, p < 0.0001). Multivariate analysis showed that KOA were significantly associated with age (odds ratio,

Revista brasileira de reumatologia, Nov 1, 2015

Purpose of review To highlight recent evidence regarding the contribution of traditional and nont... more Purpose of review To highlight recent evidence regarding the contribution of traditional and nontraditional [e.g. inflammatory markers, rheumatoid arthritis (RA) features] risk factors toward the excess cardiovascular risk in RA. Recent findings The impact of traditional risk factors on the development of cardiovascular disease in persons with RA is an area of active research. Some are more prevalent among people with RA (e.g. smoking); others appear to have paradoxical relationships (e.g. body mass index), and findings remain inconsistent with others (e.g. dyslipidemia). Collectively the data suggest that cardiovascular risk factors behave differently in RA. Thus, risk scores developed for the general population based on traditional cardiovascular risk factors alone are unlikely to accurately estimate cardiovascular risk in RA, highlighting the need for RA-specific risk prediction tools. Nontraditional risk factors, in particular RA disease activity/severity measures, including inflammatory markers, disease activity scores, seropositivity, physical disability, destructive changes on joint radiographs, extra-articular manifestations, and corticosteroid use, have repeatedly shown significant associations with increased cardiovascular risk. Medications used to treat RA may also affect cardiovascular risk. A recent meta-analysis suggests that all nonsteroidal anti-inflammatory drugs confer some cardiovascular risk. The cardiovascular risks/benefits associated with use of disease-modifying antirheumatic drugs and/or biologics remain controversial, as does the role of statins in RA. Summary Cardiovascular disease remains a major problem for people with RA. Future work should focus on further delineating the underlying biological mechanisms involved, developing and evaluating risk assessment tools and biomarkers, as well as prevention/treatment strategies specific to the RA population.

Lupus, Dec 1, 2005

We have analysed in vitro the complement-fixing activity of anticardiolipin antibodies (C-fix aCL... more We have analysed in vitro the complement-fixing activity of anticardiolipin antibodies (C-fix aCL) from patients with persistent and moderate/high titres IgG aCL antibodies: 21 with thrombosis and 11 without thrombosis. Titre and C-fix ability of aCL were measured by ELISA. APS and non-APS patients were similar with regard to mean levels of IgG aCL (46 ± 24 versus 51 ± 30 GPL, P = 0.7), frequency of IgM aCL ( P = 0.7) and a comparable predominance of IgG2 aCL reactivity on ELISA (95% versus 100%, respectively, P = 1.0 ). Remarkably, a high frequency of C-fix aCL (71% versus 92%, P = 0.35) was observed in both groups. Similarly, no difference was observed in the mean level of C-fix aCL in APS and non-APS patients (7 ± 6 versus 9 ± 8 SDunits, P = 0.3). Analysis of 10 primary and 11 secondary APS also revealed a comparable IgG aCL mean titre (57 ± 29 versus 37 ± 11, P = 0.06), frequency of IgM aCL ( P = 0.6) and of C-fix aCL (70% versus 73%, P = 0.99). Among APS patients six had exclusive arterial events and seven exclusive venous events. The IgG aCL mean titre (36 ± 10 versus 36 ± 11 GPL, P = 0.9) and the frequency of IgM aCL antibodies ( P = 0.56) in these subgroups of patients were comparable. There was a trend of higher frequency of C-fix aCL in patients with exclusive venous events (100%) compared to 50% of those with exclusive arterial events (p = 0.07). Importantly, C-fix aCL titre was higher in the former group compared to the later one (8 ± 5 SDunits versus 2 ± 2 SDunits, P = 0.016). Our data support the notion of a high frequency of C-fix aCL in APS. Although it does not discriminate those patients without thrombotic events with persistent moderate/high levels of aCL, this property seems to be more relevant in venous events and may provide the basis for further understanding the distinct pathogenic mechanisms underlying arterial and venous occlusive disorders of APS.

Postgraduate Medical Journal, Nov 1, 1999

We report the case of a 40-year-old women with diVuse uveitis, sensorineural hearing loss and cer... more We report the case of a 40-year-old women with diVuse uveitis, sensorineural hearing loss and cerebrospinal fluid pleocytosis as features of Vogt-Koyanagi-Harada syndrome who developed symmetric polyarthritis and stiVness of small and large joints, in addition to rheumatoid arthritis. Although their target tissues are distinct, both diseases have a possible autoimmune origin strongly associated with HLA-DRB4.

Revista Brasileira De Reumatologia, Nov 1, 2015

Material and methods: A descriptive cross-sectional study with 71 patients with established RA. T... more Material and methods: A descriptive cross-sectional study with 71 patients with established RA. The instruments used were: DAS-28, HAQ and SF-36, and the following parameters were determined: the erythrocyte sedimentation rate, capillary blood glucose; total cholesterol (TC) and its fractions, thyroid hormones, antinuclear antibodies (ANA), rheumatoid factor (RF) and antibodies against citrullinated proteins (ACPAs). Patients were classified into groups HAQ ≤ 1 (mild dysfunction) and HAQ > 1 (moderate and severe dysfunction) and, according to the HAQ scores, in groups treated with corticosteroids (CS) and without CS. Results: 9 patients were male and 62 female with mean age and duration of disease of 53.45 (±10.7) and 9.9 (±8.6), respectively. RF was positive in 52 (76%), ACPAs in 54 (76.1%) and ANA in 12 (16.9%). Thirty-six patients (50.7%) had systemic hypertension, 9 (12.68%) diabetes mellitus, 16 (22.5%) hypothyroidism, 33 (46.5%) dyslipidemia and 8 (11.27%) were smokers. The results of TC > 240 were found in 53.8% for group HAQ > 1 (26) and in 24.4% for group HAQ ≤ 1 (45) (p = 0.020). These groups did not differ as to presence of comorbidities or drug treatment. Triglyceride levels >200 for the group with CS (42.4%) versus without CS (18.42%) were significant (p = 0.025). Conclusion: An association of increased TC and triglycerides with results of HAQ ≤ 1 and with CS use was noted, reinforcing the importance of screening risk factors associated with cardiovascular disease in RA.

Even3 Publicações eBooks, 2023

Revista Brasileira de Reumatologia, 2012

Glucocorticoids (GC) are used in almost all medical specialties, and approximately 0.5% of the ge... more Glucocorticoids (GC) are used in almost all medical specialties, and approximately 0.5% of the general population of the United Kingdom receives those medications. With the increased survival of patients with rheumatological diseases, morbidity secondary to the use of those medications represents an important aspect of the management of our patients. The incidences of vertebral and non-vertebral fractures are elevated, ranging from 30% to 50% of the individuals on GC for over three months. Thus, osteoporosis and frailty fractures should be prevented and treated in all patients initiating or already on GC. There are several recommendations on this topic elaborated by several international societies, but consensus still lacks. Recently, the American College of Rheumatology has published new recommendations, but they are based on the WHO Fracture Risk Assessment Tool (FRAX®) to evaluate the risk for each individual, and, thus, cannot be completely used for the Brazilian population. Thus, the Committee for Osteoporosis and Bone Metabolic Disorders of the Brazilian Society of Rheumatology, along with the Brazilian Medical Association and the Brazilian Association of Physical Medicine and Rehabilitation, has elaborated the Brazilian Guidelines for Glucocorticoid-Induced Osteoporosis (GIO), based on the better available scientifi c evidence and/or expert experience. Method of evidence collection: The bibliographic review of scientifi c articles of this guideline was performed in the MEDLINE database. The search for evidence was based on real clinical scenarios, and used the following keywords (MeSH terms

British Journal of Ophthalmology, May 1, 2003

Aniridia-associated cytogenetic rearrangements suggest that a position effect may cause the mutan... more Aniridia-associated cytogenetic rearrangements suggest that a position effect may cause the mutant phenotype. Hum Mol Genet 1995;4:415-22. 3 Nishimura DY, Swiderski RE, Alward WL, et al. The forkhead transcription factor gene FKHL7 is responsible for glaucoma phenotypes which map to 6p25. Nat Genet 1998;19:140-7. 4 Flomen RH, Vatcheva R, Gorman PA, et al. Construction and analysis of a sequence-ready map in 4q25: Rieger syndrome can be caused by haploinsufficiency of RIEG, but also by chromosome breaks approximately 90 kb upstream of this gene. Genomics 1998;47:409-13. 5 Gardner RJM, Sutherland GR. Chromosome abnormalities and genetic counselling.

Anais do Congresso Brasileiro de Reumatologia 2020, 2021

BACKGROUND Knee osteoarthritis reduces physical function increasing the risk of developing other ... more BACKGROUND Knee osteoarthritis reduces physical function increasing the risk of developing other chronic conditions. We aimed to estimate the prevalence of symptomatic knee osteoarthritis (KOA) not related to trauma in a rural community in Brazil and to study the relationship between age, gender, body mass index (BMI), abdominal obesity and the most frequent self-assessed chronic diseases with KOA. MATERIALS AND METHODS This was a cross-sectional study in which randomly selected individuals over 15 years old from a rural community were administered a structure questionnaire to collect demographic data and self-reported chronic diseases. We carried out standardized measurement of patients' height, weight and waist circumference. Body mass index were categorized as normal (< 25 kg/m2) and overweight/obesity (≥ 25 kg/m2). Abdominal obesity was defined as waist circumference ≥ 94 cm for men and ≥ 80 cm for women. Participants were classified as having knee OA if they fulfilled the American College of Rheumatology (ACR) clinical criteria for knee OA1. Student t or qui-squared tests were used to compare those with and without knee OA. Significant (two-tailed p < 0.05) variables were chosen for multivariate analysis by logistic regression, one model with BMI and another one with abdominal obesity. The ethics committee from Universidade Federal da Grande Dourados approved the study (CAAE: 69543517.6.0000.5160) and all participants signed an informed consent for participation. RESULTS We included 372 people, 212 (57%) women with a mean age of 46.5 (18.3) years. Prevalence of symptomatic KOA not related to trauma was 14.52% (95% CI = 11.3-18.46). People with KOA were older (57.70 ± 14.46 vs. 46.66 ± 18.23 years old, p < 0.0001) more likely to be women (77.78 vs. 53.46%, p = 0.001). They also have higher frequency of hypertension (50 vs. 26.41%, p = 0.001), type 2 diabetes (33.33 vs. 8.18%, p < 0.0001), dyslipidaemia (27.78 vs. 11.78%, p = 0.009), anxiety/depression (38.89 vs. 14.46%, p < 0.0001), overweight/obesity (83.33 vs. 61%, p = 0.003) and abdominal obesity (92.59 vs. 61.63%, p < 0.0001). Multivariate analysis showed that KOA were significantly associated with age (odds ratio,

Anais do Congresso Brasileiro de Reumatologia 2020, 2021

BACKGROUND Musculoskeletal diseases can worsen metabolic syndrome (MetS) as patients develop sede... more BACKGROUND Musculoskeletal diseases can worsen metabolic syndrome (MetS) as patients develop sedentary behaviors leading to loss of muscle which can damage other musculoskeletal structures. Therefore, we aimed to study musculoskeletal diseases in patients with MetS by comparing clinical and laboratory features between groups with and without MetS. MATERIALS AND METHODS This case-control study included 64 and 42 individuals with and without MetS, respectively, with similar age, and sex distribution recruited between June 2018 and September 2019. They underwent medical evaluation for the diagnosis of musculoskeletal disorders lasting more than 12 weeks and also to documented metabolic syndrome features. First univariate analysis was carried out for laboratory parameters, each musculoskeletal site and also for knee osteoarthritis, plantar fasciitis and fibromyalgia. Variables resulting significant or with marginal significance were selected for multivariate analysis by logistic regression. The ethics committee from UFGD approved the study (CAAE57333816.5.0000.5160) and all participants signed an informed consent for participation.

Blucher Medical Proceedings, 2019

Lupus, 2004

Sir—Vogt–Koyanagi–Harada (VKH) syndrome is an autoimmune disease targeted against pigmented tissu... more Sir—Vogt–Koyanagi–Harada (VKH) syndrome is an autoimmune disease targeted against pigmented tissues in a susceptible individual. It is characterized by a diffuse intraocular in ammation, in the absence of a previous ocular trauma, associated or not with central nervous system (CNS) and skin manifestations. Even though the cellular component of uvea inŽ ltration is mainly composed of CD4 T-cells, components of a humoral response, such as B-cells, complement and immunoglobulin depositions, are also found, suggesting that they may play a role in its pathogenesis. In the present study we analysed the presence of systemic autoantibodies in VKH syndrome as a model of tissue-speciŽ c autoimmune disease in which uveitis is the main feature. Sera samples from 23 patients with VKH, eight with Behçet’s disease (BD) and four with ankylosing spondylitis (AS), all with intraocular in ammation, were analysed. Sera from 20 normal controls were also tested. Detection of autoantibodies to anti-SS-A/Ro and anti-SS-B/La was performed by counter immunoelectrophoresis. Antinuclear (ANA), anti-double stranded (ds) DNA, anti-Sm, anti-RNP antibodies and rheumatoid factor (RF) were determined by standard processes. We slightly modiŽ ed the ELISA assay to detect anti-histone antibodies described by Monastier et al. 5 by the use of bovine gammaglobulin 0.1% in the diluents and blocking solutions. Four of 23 VKH patients (17%) had a positive immuno uorescence with Hep-2 cells. Two sera had a Ž ne nuclear speckled pattern, one a nuclear homogeneous and one a speckled cytoplasmatic. The Ž rst two sera were positive to anti-SS-A/Ro. Interestingly, neither of these patients has complaints of dry eyes or mouth and both have a normal tear function documented by Schirmer test and rose Bengal staining. In contrast, all sera from patients with BD and AS, as well as from normal controls, were uniformly negative. Similarly, no antibodies were detected against Sm, RNP, histone and dsDNA in any tested group. Two VKH patients were RF positive and both sera were negative to anti-SS-A/Ro. One of them had the rare association of VKH and rheumatoid arthritis. No association with active eye in ammation was observed in the ANA positive group. It may be relevant that all patients with active disease were under prednisone alone or in association with other immunosuppressive therapy. Concerning anti-SS-A/Ro antibodies, one of the patients was under prednisone therapy (10 mg/day). This is the Ž rst report of anti-SS-A/Ro antibodies in VKH syndrome. It is remarkable that the high frequency of 10% observed herein is almost 20 times greater than that described by Fritzler et al. 7 in 2500 blood donor women. Furthermore, the use of immunosuppressive therapy in almost half of our patients may have underestimated our results. Even though 80% of patients with anti-SS-A/Ro antibodies usually have rheumatoid factor, in the present data both patients positive for these antibodies and VKH neither had Sjögren syndrome or rheumatoid factor. It is described that some anti-SS-A/Ro antibodies have an intrinsic RF activity. In conclusion, we report for the Ž rst time the presence of these antibodies in sera from patients with VKH by a highly speciŽ c method. Its role in the pathogenesis of the disease should be further investigated since it has been demonstrated that its 60 kDa protein has a sequence homology with the carboxy-terminal sequence of calreticulin. High reactivity against calreticulin is described in onchocerciasis eye diseases. Interestingly, the histopathology of experimental studies in rabbits suggested that it started with a choroiditis and is followed by a secondary degeneration of the overlying pigment epithelium and neuroretin, Ž ndings partially similar to those found in VKH syndrome. Taken together, there are some similarities between VKH syndrome and ocular onchocerciasis regarding some aspects of ocular histopathological Ž ndings. Whether the diseases could have a shared target autoantigen will be the subject of further research.

British Journal of Ophthalmology, 2003

Aniridia-associated cytogenetic rearrangements suggest that a position effect may cause the mutan... more Aniridia-associated cytogenetic rearrangements suggest that a position effect may cause the mutant phenotype. Hum Mol Genet 1995;4:415-22. 3 Nishimura DY, Swiderski RE, Alward WL, et al. The forkhead transcription factor gene FKHL7 is responsible for glaucoma phenotypes which map to 6p25. Nat Genet 1998;19:140-7. 4 Flomen RH, Vatcheva R, Gorman PA, et al. Construction and analysis of a sequence-ready map in 4q25: Rieger syndrome can be caused by haploinsufficiency of RIEG, but also by chromosome breaks approximately 90 kb upstream of this gene. Genomics 1998;47:409-13. 5 Gardner RJM, Sutherland GR. Chromosome abnormalities and genetic counselling.

Clinical Rheumatology, 2016

It has been suggested that hearing impairment (HI) is one of the extra-articular features of rheu... more It has been suggested that hearing impairment (HI) is one of the extra-articular features of rheumatoid arthritis (RA). Nevertheless, the prevalence and nature of HI in RA is still uncertain. The objectives were to study hearing function in patients with RA using audiometric tests and to examine whether HI correlates with autoantibodies. Hearing functions were investigated in 43 consecutive RA patients and 23 control subjects (less than 60 years old). Their sera were evaluated for the presence of rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), and anti-mutated citrullinated vimentin (anti-MCV) antibodies. HI was observed in 46.5 % of RA patients and in 30.4 % of control subjects, p = 0.32. HI was characterized as sensorineural in 80 and 85.7 % of RA patients and control subjects with HI, respectively, p = 1.00. RA patients had a worse hearing threshold for air conduction at 6 kHz in the right ear (p = 0.019) and had a decreased amplitude of otoacoustic emissions (OAEs) at 2 kHz bilaterally (p = 0.04) compared with control subjects. In the RA group, patients with and without HI were 80 and 34.78 % anti-CCP positive, respectively, p = 0.008. RA patients with and without HI were 85 and 43.48 % anti-MCV positive, respectively, p = 0.013. HI in RA patients was mainly sensorineural and was associated with anti-CCP and anti-MCV antibodies.

Blucher Medical Proceedings, 2019

The Brazilian guidelines for prevention and treatment of glucocorticoid-induced osteoporosis were... more The Brazilian guidelines for prevention and treatment of glucocorticoid-induced osteoporosis were updated and important topics were included such as assessment of risk fracture using FRAX Brazil, use of denosumab, and also recommendations for the use of glucocorticoid pulse therapy and inhaled glucocortiocoid. Introduction Glucocorticoids (GCs) are used in almost all medical specialties and the incidences of vertebral/nonvertebral fractures range from 30 to 50% in individuals treated with GCs for over 3 months. Thus, osteoporosis and frailty fractures should be prevented and treated in patients initiating treatment or already being treated with GCs. The Committee for Osteoporosis and Bone Metabolic Disorders of the Brazilian Society of Rheumatology (BSR) established in 2012 the Brazilian Guidelines for glucocorticoid-induced osteoporosis (GIO). Herein, we provide a comprehensive update of the original guidelines based on improved available scientific evidence and/or expert experience. Methods From March to June 2020, the Osteoporosis Committee of the BRS had meetings to update the questions presented in the first consensus (2012). Thus, twenty-six questions considered essential for the preparation of the recommendations were selected. A systematic literature review based on real-life scenarios was undertaken to answer the proposed questions. The MEDLINE, EMBASE, and SCOPUS databases were searched using specific search keywords. Results Based on the review and expert opinion, the recommendations were updated for each of the 26 questions. We included 48 new bibliographic references that became available after the date of the publication of the first version of the consensus. Conclusion We updated the Brazilian guidelines for the prevention/treatment of GIO. New topics were added in this update, such as the assessment of risk fracture using FRAX Brazil, the use of denosumab, and approaches for the treatment of children and adolescents. Furthermore, we included recommendations for the use of inhaled GCs and GC pulse therapy in clinical settings.

Lupus, 2005

We have analysed in vitro the complement-fixing activity of anticardiolipin antibodies (C-fix aCL... more We have analysed in vitro the complement-fixing activity of anticardiolipin antibodies (C-fix aCL) from patients with persistent and moderate/high titres IgG aCL antibodies: 21 with thrombosis and 11 without thrombosis. Titre and C-fix ability of aCL were measured by ELISA. APS and non-APS patients were similar with regard to mean levels of IgG aCL (46 +/- 24 versus 51 +/- 30 GPL, P = 0.7), frequency of IgM aCL (P = 0.7) and a comparable predominance of IgG2 aCL reactivity on ELISA (95% versus 100%, respectively, P = 1.0). Remarkably, a high frequency of C-fix aCL (71% versus 92%, P = 0.35) was observed in both groups. Similarly, no difference was observed in the mean level of C-fix aCL in APS and non-APS patients (7 +/- 6 versus 9 +/- 8 SDunits, P = 0.3). Analysis of 10 primary and 11 secondary APS also revealed a comparable IgG aCL mean titre (57 +/- 29 versus 37 +/- 11, P = 0.06), frequency of IgM aCL (P = 0.6) and of C-fix aCL (70% versus 73%, P = 0.99). Among APS patients six had exclusive arterial events and seven exclusive venous events. The IgG aCL mean titre (36 +/- 10 versus 36 +/- 11 GPL, P = 0.9) and the frequency of IgM aCL antibodies (P = 0.56) in these subgroups of patients were comparable. There was a trend of higher frequency of C-fix aCL in patients with exclusive venous events (100%) compared to 50% of those with exclusive arterial events (p = 0.07). Importantly, C-fix aCL titre was higher in the former group compared to the later one (8 +/- 5 SDunits versus 2 +/- 2 SDunits, P = 0.016). Our data support the notion of a high frequency of C-fix aCL in APS. Although it does not discriminate those patients without thrombotic events with persistent moderate/high levels of aCL, this property seems to be more relevant in venous events and may provide the basis for further understanding the distinct pathogenic mechanisms underlying arterial and venous occlusive disorders of APS.