Renata Aguiar - Academia.edu (original) (raw)

Papers by Renata Aguiar

PubMed, Dec 29, 2021

Systemic lupus erythematosus (SLE) is an autoimmune disease with potential multisystemic involvem... more Systemic lupus erythematosus (SLE) is an autoimmune disease with potential multisystemic involvement. Mesenteric panniculitis (MP) has been described as a rare feature in patients with SLE. The authors present a case of a 26 years old patient with previous diagnosis of SLE presenting with abdominal pain and distension and a peri-umbilical mass. Imagological findings were compatible with MP and ganglion biopsy revealed inflammatory pattern. Corticosteroid therapy was initiated with a resolution of pain after 6 months of treatment, with image reevaluation showing improvement of previous findings.

Scandinavian Journal of Rheumatology, Jun 6, 2022

UCL Discovery (University College London), Sep 2, 2017

axSpA patients with different gender, age, disease duration, and educational background. Results:... more axSpA patients with different gender, age, disease duration, and educational background. Results: Minor difficulties arose from the translation process of the ASAS-HI. The EF Item Set offered more difficulties indicating that concepts underlying the contextual factors may be more culture-dependent. A total of 10 patients with axSpA [8 males, mean age of 41.4 (±13.7)] participated in the field test. Cognitive debriefing showed that items of the ASAS-HI and EF Item Set of the Portuguese version are clear, relevant, understandable and easy to complete. As a result of cognitive debriefing, the wording of four items had to be changed to avoid misunderstandings or unintended interpretations, and a new response option "not applicable" was added to two items of the ASAS-HI to improve appropriateness. Conclusions: The resulting Portuguese version of the ASAS-HI and ASAS-EF showed acceptable linguistic validity and has potential for use in both clinical practice and research settings. Nevertheless, before European Portuguese versions can be fully implemented, its psychometric properties (validity and reliability) need to be evaluated.

analyses to search for baseline factors of work impact at 1-2 years (including a medium/high ASWI... more analyses to search for baseline factors of work impact at 1-2 years (including a medium/high ASWIS score, gender, age, schooling level, BASDAI, BASFI). Results: Among the 188 patients who answered the first questionnaire, 144 were currently working and were asked to answer the second questionnaire. A total of 101 patients answered both questionnaires. Mean age at inclusion was 45 (SD 9) years, 52% were male, disease duration was 14 (SD 8) years and 62% had an education level equivalent to more than high school. The BASDAI and the BASFI were respectively 34 (SD 21) and 23 (SD 23). At baseline, median ASWIS was 10, a low-risk score was found in 55 patients (54%), and a medium/high risk score in 46 (46%). 1-2 years later, 37 patients (36%) had work impact: 25 patients (25%) a short-term sick leave, and 12 patients (12%) a significant work impact (long-term disability or unemployment due to Ax-SpA). Among patients with a low ASWIS score at baseline (n=55), only 13 (24%) had a work impact (including only 2 with a significant impact). Among patients with a medium/high ASWIS score (n=46), 24 (52%) had a work impact (including 10 patients of a significant impact). In univariate analysis, baseline factors associated with work impact (moderate or significant) were a medium/high ASWIS score, a high BASFI and a shorter disease duration. In multivariate analysis, medium/high ASWIS (odds ratio, OR 2.71 (1.04-7.22)) and a lower disease duration (0.94 (0.89-0.99)) were independent predictive factors of work impact. Conclusions: In patients with axSpA, a medium/high ASWIS score was followed by a work impact in 50% of cases within 2 years in this well-controlled population. This short questionnaire can be helpful to screen for future difficulties at work, whatever the stage of disease. References: [1] Gilworth G, et al. Reducing work disability in ankylosing spondylitis: development of a work instability scale for AS.

PubMed, Mar 27, 2022

Sjogren's syndrome (SS) is an autoimmune pathology which mainly affects salivary and lacrimal gla... more Sjogren's syndrome (SS) is an autoimmune pathology which mainly affects salivary and lacrimal glands. Cerebellar degeneration association with SS is very rare, with only a few cases described. The treatment of SS with central nervous system involvement is not consensual. We present a 48-year-old woman with dysarthria, diplopia and ataxia associated with xerostomia. The brain magnetic imaging revealed bilateral cerebellar atrophy. She had antibody positivity for anti-SSA and anti-SSB and minor salivary glands biopsy revealed lymphocytic infiltration. Methylprednisolone, cyclophosphamide and intravenous immunoglobulin yielded no results. Rituximab was initiated with improvement in dysarthria and coordination.

Revue du Rhumatisme, Dec 1, 2020

Artificial intelligence (AI) systems too complex for predefined environment models and actions wi... more Artificial intelligence (AI) systems too complex for predefined environment models and actions will need to learn environment models and to choose actions that optimize some criteria. Several authors have described mechanisms by which such complex systems may behave in ways not intended in their designs. This paper describes ways to avoid such unintended behavior. For hypothesized powerful AI systems that may pose a threat to humans, this paper proposes a two-stage agent architecture that avoids some known types of unintended behavior. For the first stage of the architecture this paper shows that the most probable finite stochastic program to model a finite history is finitely computable, and that there is an agent that makes such a computation without any unintended instrumental actions.

Revue du Rhumatisme, Dec 1, 2021

Annals of the Rheumatic Diseases, Jun 1, 2014

Background: The foot is one of the most complex components of musculoskeletal system, and also on... more Background: The foot is one of the most complex components of musculoskeletal system, and also one of the less addressed in literature. However, its importance in daily activities (gait, posture, etc) has led to a growing concern in understanding the functional mechanisms and joint kinetics of the foot. Foot involvement, whether articular or enthesopatic, is well known in axial spondyloarthritis (aSpa) and peripheral spondyloartrhritis (pSpa). However, data on literature are scarce, and the true impact in patients is unknown. Objectives: To determine the prevalence of functional impairment of the foot and tibiotarsal joint in a cohort of patients with aSpa and pSpa and its relation with disease duration, activity and function indexes. Methods: Cross sectional study. Analyzed variables: gender, age and disease duration. Every patient answered the FAOS (Foot and Ankle Outcome Score) questionnaire, which assesses pain, functional aspects of the foot and tibiotarsal joint and its impact on quality of life and daily activities. In patients with aSpa, BASDAI and BASFI were obtained, as well as DAS28 in patients with pSpa. Control group: healthy individuals, adjusted by gender and age to patients. Statistical analysis with SPSS ® version 18.0 Results: Eighty patients were enrolled (38 with aSpa and 42 with pSpa), 50 males and 30 females; mean age was 47.3±14.24 years old and mean disease duration was 8.96±10.02 years. Mean DAS28 was 2.49±1.08, mean BASFI was 3.67±2.55 and mean BASDAI was 4.35±2.32. Mean FAOS was 85.5±11.1 on aSpa (mild symptoms) and 77.6±16.1 on pSpa (mild to moderate symptoms). Compared to control group, pSpa patients had lower FAOS values (p<0.03); this difference wasn't statistically significant with aSpa patients. Although lower FAOS values were found in females and older patients, this difference wasn't statistically significant. A statistically significant negative correlation was found between FAOS values and disease duration in pSpa patients (p<0.03). A statistically significant negative correlation was also found between disease activity and FAOS values (p<0.04 in aSpa and p<0.02, in pSpa); BASFI values also correlated negatively with FAOS (p<0.04). Conclusions: In our cohort, most of patients assumed the presence of mild to moderate functional impairment, especially those with pSpa, as expected. Foot involvement seems to relate directly with disease activity, in both aSpa and pSpa, and with disease duration in pSpa.

Annals of the Rheumatic Diseases, Jun 1, 2013

Methods: 77 post-menopausal women older than 65, having osteoporosis, have been analyzed. Upon co... more Methods: 77 post-menopausal women older than 65, having osteoporosis, have been analyzed. Upon completed densitometry examination of lumbosacral part of the spine (LS) L1-L4 and the hip, which helped identification of osteoporosis, X-ray test of the Th4-L5 portion of the spine was made for all the patients, aimed at detecting vertebral fractures, AP and profile, which have been analyzed by semi-quantitative method (Genant,1993); the analysis was made by a radiologist. Patients were treated with weekly (82%),monthly(13%) and intravenous(5%) bisfosfonates, 5600 weekly vitamin D3 supplementation and calcium carbonate 500 IU daily. During three years of treatment, follow up was done for vertebral fractures, any new fractures and BMD changes. Results: Average age of the patients ranged between 70,4±6,8 years, at the beginning, and average age at the end of study ranged between 73±7,2 years. BMI 24.4±5.9kg/m2, at the end 22± kg/m2, height 155.8±4.5cm, at the end 154±3,2, menopause started 18.9±5.4 years ago. Vertebral fractures were found out in 21 patients(27.27%). Symptomatic fractures were reported by 4 (19.04%)5,1%, patients whereas 17(80.95%)22,1% patients had the asymptomatic ones. One fracture was registered with 11 (53%) patients, 2 fractures with 6 (29%), and 3 and more with 4 (19%) patients. 1st degree fractures, according to Genant, were found out in 12 (57%), 2nd degree fractures were registered with 8 (38%) patients and 3rd degree fractures with 1(5%) patient. Study was finished after three years, and same diagnostic procedures were made(RTG, DXA). On follow up there were 71 (92,2%)patients, one developed colon carcinoma(1,2%), 2 died from cardiovascular death (2,5), and 3 left study due to gastrointestinal reasons 3,8%. Since it concerns fractures, one had fracture of femur (1,3%), two (2,7%) fractures of radius loco typico, and there were no new vertebral fractures. New fractures occurred in a group which did not have registered vertebral fractures at the beginning of the study. Increase of BMD and Tscore was noticed.The folow up is statistically significant in regard to the beginning on LS 6%, on hip 4% P<0,01,. Conclusions: The results obtained from research indicate a high percentage of asymptomatic vertebral fractures in the examined group of elderly postmenopausal women having osteoporosis. After three years of treatment with bisfosfonates they had low percent of new fractures, there was increase of BMD registered, no new vertebral fractures, and three new non-vertebral fractures.

African journal of thoracic and critical care medicine, Dec 19, 2022

Background. Hypersensitivity pneumonitis (HP) is a syndrome caused by sensitisation to inhaled an... more Background. Hypersensitivity pneumonitis (HP) is a syndrome caused by sensitisation to inhaled antigens that leads to an abnormal immune response in the airways and lung parenchyma. Some patients previously diagnosed with certain types of fibrotic interstitial lung diseases (f-ILDs), including fibrotic HP (f-HP), are susceptible to develop a progressive fibrosing phenotype (PF-ILD), despite initial stateof-the-art management. Objectives. To characterise a cohort of patients with a multidisciplinary diagnosis (MTD) of chronic f-HP, who were followed up in an ILD outpatient clinic of a hospital in Portugal, and to assess the prevalence of PF-ILD criteria in these patients. Methods. Data were collected from all patients with a definite or provisional diagnosis of f-HP after a multidisciplinary team discussion. Patients were followed up between December 2014 and July 2019. Data included clinical characteristics, high-resolution chest tomography (HRCT) disease patterns, lung function tests, bronchoalveolar lavage and further immunological work-up, biopsy reports (conventional transbronchial lung biopsy, transbronchial lung cryobiopsy or surgical video-assisted thoracoscopic lung biopsy), all ILD multidisciplinary team records and diagnostic confidence levels. Patients were assessed according to PF-ILD criteria as defined in the INBUILD trial. Results. We identified 83 patients with an MTD of HP, who had been followed up for at least 12 months. Of these, 63 (75.9%) were diagnosed with f-HP. Of the 63 f-HP patients, 33.3% (n=21) fulfilled the predefined criteria for PF-HP: 66.7% had a relative decline of ≥10% forced vital capacity (FVC); 5% a relative decline of 5-9% FVC, with worsening symptoms or increased fibrosis on HRCT; and 23.8% had worsening respiratory symptoms with radiological progression. Conclusion. This single-centre cohort study demonstrated that a third of f-HP patients presented with PF-ILD, as determined by progression during initial standard-of-care treatment. A usual interstitial pneumonia (UIP)/UIP-like pattern was present in >70% of patients with f-HP, and two-thirds of these patients had an FVC decline of ≥10%. PF-HP patients were also more exacerbation prone. According to recent trial data, this segment of patients can be considered possible candidates for antifibrotic treatment, with a reasonable prospect of effectiveness. Further efforts should focus on refining knowledge of longitudinal behaviour of large multicentric cohorts of f-HP patients, establishing a consensual and uniform definition of progression for use in clinical practice, as well as developing prognostic prediction tools to better (and early) inform the disease course.

ARP rheumatology, Oct 16, 2022

Sjogren's syndrome (SS) is an autoimmune pathology which mainly affects salivary and lacrimal gla... more Sjogren's syndrome (SS) is an autoimmune pathology which mainly affects salivary and lacrimal glands. Cerebellar degeneration association with SS is very rare, with only a few cases described. The treatment of SS with central nervous system involvement is not consensual. We present a 48-year-old woman with dysarthria, diplopia and ataxia associated with xerostomia. The brain magnetic imaging revealed bilateral cerebellar atrophy. She had antibody positivity for anti-SSA and anti-SSB and minor salivary glands biopsy revealed lymphocytic infiltration. Methylprednisolone, cyclophosphamide and intravenous immunoglobulin yielded no results. Rituximab was initiated with improvement in dysarthria and coordination.

OBJECTIVE: The Assessments of SpondyloArthritis international Society Health Index (ASAS HI), est... more OBJECTIVE: The Assessments of SpondyloArthritis international Society Health Index (ASAS HI), estimates the impact of Spondyloarthritis (SpA) on global functioning and health. This article assesses the construct validity, reliability and responsiveness of the Portuguese version of the ASAS HI. PATIENTS AND METHODS: Patients fulfilling ASAS classification criteria for axial (axSpA) or peripheral SpA (pSpA) were included. Construct validity was assessed through Spearman's correlation analysis with other health outcomes. Discriminant validity was tested comparing the ASAS HI across disease activity and functional states using the Kruskal-Wallis test. Internal consistency was assessed by Cronbach's α, and test-retest reliability by intraclass correlation coefficients (ICC). Responsiveness was evaluated by the standardized response mean (SRM) in patients with active disease who required therapy escalation. RESULTS: Among the 91 patients included, 67% were male, mean (SD) age 47.2...

International Journal of Rheumatic Diseases

Annals of the Rheumatic Diseases

BackgroundAnti-Ro/SSA antibodies are directed against different proteins of intracellular small r... more BackgroundAnti-Ro/SSA antibodies are directed against different proteins of intracellular small ribonucleic acid (RNA)-protein complexes, Ro60 (60 kDa) and Ro52 (52 kDa) and are the most frequently detected autoantibodies in patients´ sera. The clinical associations with antibodies to the Ro60 protein is well documented and includes systemic lupus erythematosus (SLE) and Sjögren syndrome (SS). [1]The presence of anti-Ro52 antibodies has been reported in a large variety of diseases, such as neoplastic diseases or viral infections [1, 2].ObjectivesThe aim of this study was to analyze the clinical relevance and the disease phenotype of patients with anti-Ro52 and/or anti-Ro60 autoantibodies in a single portuguese tertehospital.MethodsRetrospective and descriptive study included all patients screened for anti-nuclear antibodies (ANA) in the database of the immunology laboratory of our Hospital between 2017 and 2021. Only adult patients (≥ 18-years-old) with positive anti-Ro52 and/or Ro6...

Annals of the Rheumatic Diseases

BackgroundInterstitial lung diseases (ILDs) are a group of heterogeneous lung disorders with vari... more BackgroundInterstitial lung diseases (ILDs) are a group of heterogeneous lung disorders with variable prognosis. Idiopathic pulmonary fibrosis (IPF) is the main idiopathic interstitial pneumonia and rheumatoid arthritis (RA) is the commonest cause of connective tissue disease related-ILD. In fact, ILD is the most frequent form of respiratory involvement in RA, with 10% patients having clinically significant disease, frequently imposing significant morbi-mortality. RA-ILD can potentially comprise different disease patterns with distinct prognosis, with usual interstitial pneumonia (UIP) being the most frequent radio-histological pattern. Several studies have suggested that the RA-UIP disease course and survival may be clinically similar to IPF.ObjectivesThis study aimed to investigate comparative clinical features, longitudinal behaviour and healthcare resource utilization between local cohorts of RA-UIP and IPF patients.MethodsRetrospective and descriptive study including all IPF an...

Annals of the Rheumatic Diseases, 2013

Background The impact of rheumatic diseases on patients’ sexuality has been, for a long time, an ... more Background The impact of rheumatic diseases on patients’ sexuality has been, for a long time, an ignored topic. As quality of life in these patients became more valorized, sexuality, as a major aspect for the individual’s well being, arised as a subject to be considered over the last decade1. The awareness of the physicians for the problem is of great importance, since the impact in sexual life might be a major concern and still, a quite uncomfortable topic for the patient – both with healthcare professionals and partners. Objectives To analyze the approach by the healthcare service and/or partners on the patients’ perspective of the impact of the rheumatic disease in their sexual activity. Methods An anonymous questionnaire was performed, consisting in demographic data (sex, age, disease duration, civil status, professional status and educational level), and questions related to the importance attributed to sexual activity, as well as to the approach of the topic by the patient and healthcare professionals, with multiple choice questions and questions to be answered through a visual analogical scale. A descriptive study was performed. Results 95 patients with the diagnosis of spondyloarthritis were enrolled and 76 answered the questionnaire; 31 had psoriatic arthritis, 30 had ankylosing spondylitis, 9 had undifferentiated spondyloarthritis and 6 had inflammatory bowel disease spondyloarthritis; 40 were male, 35 were female and 1 unknown. Mean age was 46.08±12.08 and mean disease duration was 12.17±10.32 years. Most of patients were married (56) or common law married (8); 19 patients had completed primary school only and less than one quarter were graduate or higher. In a visual analogical scale, mean importance give to sexual capacity was 74.67±24.55. Among the 76 patients, only 35 stated they talked about the subject with their partner; however, the great majority (66 patients) said they had the partner’s understanding towards their limitations in sexual activity. The perception of conditioning in the conjugal relationship was, in a visual analogical scale, 33.68±31.56. 58 patients had never talked about it with anyone else and 65 had never been questioned by any health professional (rheumatologist, general practitioner or nurse). Conclusions This work emphasizes that the impact of spondyloarthritis on sexual activity is a topic rarely approached either by the patients, either by health professionals. Since patients valorize a lot their sexual capacity and seem not to talk about the limitations imposed by their disease, this subject might deserve a greater attention, including from rheumatologists and other healthcare professionals. References Helland Y, Kjeken I, Steen E, Kvien TK, Hauge MI, Dafinrud H. Rheumatic Diseases and Sexuality: Disease Impact and Self-Management Strategies. Arthritis Care & Res 2011;5:743–750 Disclosure of Interest None Declared

Annals of the Rheumatic Diseases, 2013

ABSTRACT Background The impact of rheumatic diseases on patients’ sexual life has been gathering ... more ABSTRACT Background The impact of rheumatic diseases on patients’ sexual life has been gathering the attention of the scientific community over the last decade1. However, specific assessemnt tools are scarce and there are few existing studies, specially those related to spondyloarthritis2 and particularly to psoriatic arthritis. In fact, several factors may condition sexual function in these patients: pain, stiffness, decreased range of motion, joint swelling and extraarticular features such as fatigue, enthesopathy and, in the case of psoriatic arthritis, cutaneous lesions. Objectives To assess sexual satisfaction in a cohort of patients with spondyloarthritis; to identify the limitation imposed by different factors related to the disease in sexual activity; to search for relations between those limitation and quality of life and disease activity and function indexes. Methods An anonymous questionnaire was performed, consisting in two parts. One part consisted in a questionnaire filled by the physician with data on the disease – affected joints, extraarticular features, comorbidities, current treatment, metrology in patients with axial involvement, disease activity (BASDAI and/or DAS28) and function (BASFI and HAQ) indexes and quality of life index (ASQoL). The other part consisted in a questionnaire filled by the patient, with demographic data (sex, age, disease duration, civil status, professional status and educational level), multiple choice questions and questions to be answered through a visual analogical scale, including items approached in some validated indexes of sexual function and satisfaction assessment. Statistical treatment was performed using SPPS system, version 17.0. Results 95 patients with the diagnosis of spondyloarthritis were enrolled and 76 answered the questionnaire; 31 had psoriatic arthritis, 30 had ankylosing spondylitis, 9 had undifferentiated spondyloarthritis and 6 had inflammatory bowel disease spondyloarthritis; 40 were male, 35 were female and 1 unknown. Mean age was 46.08±12.08 and mean disease duration was 12.17±10.32 years. In a visual analogical scale, the mean sexual satisfaction level was 52.28±30.99; the perception of conditioning in the conjugal relationship was 33.68±31.56; limitation on sexual activity was 32.72±31.06; limitation by pain, joint swelling, fatigue, stiffness, decreased range of motion, decreased libido and psoriasis lesions varied from 29.17±28.51 (swelling) e 46.94±32.31 (fatigue), and there was no significant difference between sexes, diagnoses and type of involvement. A strong correlation was identified between most of these factors and ASQoL and HAQ values, but not between them and activity indexes. The presence of comorbidities did not influence the obtained values in a statistically significant way. Conclusions This work highlights the impact of spondyloarthritis on patients’ sexual function. Fatigue was mentioned as the most limiting factor in sexual activity, and the values obtained had a strong correlation with quality of life index in ankylosing spondylitis and with function index in psoriatic arthritis. The type of disease and joint involvement didn’t imply statistically significant differences on the analyzed parameters in this cohort of patients. Disclosure of Interest None Declared

Annals of the Rheumatic Diseases, 2015

Background: Pulmonary hypertension (PHT) may contribute to the cardiovascular (CV) morbidity in r... more Background: Pulmonary hypertension (PHT) may contribute to the cardiovascular (CV) morbidity in rheumatoid arthritis (RA); however understanding of its etiology in RA remains limited. PHT may be under-recognized in RA and may be associated with factors other than interstitial lung disease (ILD) as conventionally thought. 1 Objectives: To estimate the frequency of PHT in adult RA (age >18) and to study associations of PHT with ILD, left ventricular diastolic dysfunction (LVDD), left ventricular systolic dysfunction (LVSD) and valvular heart diseases (VHD). Methods: We identified adult RA patients with at least one transthoracic echo (TTE) performed between 1997 and 2014. The RA patients were required to have at least two visits with recorded International Classification of Disease, Ninth Revision (ICD9 code 714.0 and at least one prescription for a disease modifying anti-rheumatic drug. 2 PHT was defined as pulmonary artery systolic pressure (PASP) >35 mmHg on TTE. LVDD was defined as mild, moderate and severe as per established criteria based on mitral inflow velocities (MIV) (E and A) and lateral mitral annulus velocity (E') measured by Tissue Doppler Imaging (TDI). 3 LVSD was defined as LVEF <40%. Student's t test was used to compare continuous variables and chi-square test was used for categorical variables; p value of <0.05 was considered significant. Results: Total 187 patients satisfied inclusion criteria, of which 67 (35.8%) patients had PHT. Age, sex, race and ethnicity were not significantly different between patients with and without PHT (Table). Patients with PHT had higher frequencies of coronary artery disease, peripheral arterial disease, and chronic kidney disease; although total comorbidities were not significantly different between the groups. Isolated LVDD was the most common association of PHT found in 22 (32.8%) of cases. Severe LVDD (E/A ≥1.5) was more prevalent in patients with PHT (22.3%) as compared to without PHT (6.7%). Other associations included LVSD in 10 (14.9%) cases, LVDD plus LVSD in 7 (10.4%) cases and aortic stenosis in 3 cases (4.5%). Eleven (16.41%) patients had ILD; of which 5 patients had ILD along with LVSD, LVDD or both. No differences in frequency of ILD were found between patients with and without PHT (12.5% v/s 16.4%). Conclusions: We found that PHT was present in over one third of RA patients who had a TEE performed at our center. CV comorbidities and LVDD were the most common associations. Severe LVDD was more frequent in patients with PHT. Although limited by its retrospective design and PHT definition by TTE, this is one of the largest studies to date looking at the frequency and the association between PHT and LVDD in RA. The strengths of the study include a well-defined study population and use of more accurate measures (MIV and TDI) to define LVDD. Enhanced recognition and early intervention of CV risk factors may prevent development and progression of PHT in RA patients. References: [1] O'Dwyer DN, et al. Rheumatoid Arthritis associated interstitial lung disease.

Annals of the Rheumatic Diseases, 2013

ABSTRACT Background The loss of muscle mass (MM) is a serious problem which may cause serious ill... more ABSTRACT Background The loss of muscle mass (MM) is a serious problem which may cause serious illness and premature death. Several studies show that about two-thirds of Rheumatoid Arthritis (RA) patient’s have loss of MM, known as Rheumatoid Cachexia. Many factors were identified in the pathogenesis of this process: excessive production of cytokines TNF-α, low physical activity and reduction of the peripheral action of insulin. It is known that RA patients have higher rates of proteins degradation and it is thought that the TNF-α stimulates muscle catabolism, been described as a “sarcoactive” cytokine. The elevation of pro-inflammatory cytokines is also present in spondyloarthritis (Spa) so, like in RA, loss of MM may occur. There are few studies about the association between loss of MM and Spa and the results are discrepant so, the effect of chronic inflammation and disease activity in body composition is still unknown. Objectives Assess muscle mass index (MMI) in patients with Spa; verify if they have higher risk of sarcopenia and if the MMI is related with disease activity, functional impairment and duration of the illness. Methods Case-control study, in a population of patients with Spa (axial or peripheral). The control group were users of a Family Health Unit. Variables: sex; age; height; weight, duration of disease, pathological antecedents, chronic medication, MMI, disease activity (BASDAI and/or DAS28); BASFI and HAQ. The MMI was determinated, from the value of MM, using Lee’s equation. Results A sample of 60 patients was obtained; 52% were female. The average age was 45.5 years (± 13.4), and the average duration of the disease 10.9 years (± 11.6), 40% of patients met criteria for psoriatic arthritis (PsA). According to the classification of the MMI, 62% of the patients had sarcopenia. There was a statistically significant difference between MMI of the Spa group and the control group (7.12 ± 0.99 vs. 7.8 ± 0.93; p &lt; 0.05). The Odds ratio between cases and controls with and without sarcopenia was 2.1. In the group of patients with ankylosing spondylitis no association was found between MMI and BASFI, BASDAI, or duration of the disease. However, in the subgroup of patients with PsA with axial involvement, a very strong negative correlation was found between MMI and the BASFI (rho =- 0.823; p &lt; 0.05). Sex, concomitant medication and pathological history doesn’t seem to influence the degree of sarcopenia. Conclusions This study shows that the risk of sarcopenia in Spa patients is twice than in the control group. It hasn’t possible to identify the factors associated with that loss of MM, with the exception of a small group of patients with axial PsA, where a worse functional capacity was related with higher levels of sarcopenia. The limitations of this study were: use of a non validated equation to calculate MM, small number of the sample and the bias of measurement. Disclosure of Interest None Declared

Annals of the Rheumatic Diseases, 2013

PubMed, Dec 29, 2021

Systemic lupus erythematosus (SLE) is an autoimmune disease with potential multisystemic involvem... more Systemic lupus erythematosus (SLE) is an autoimmune disease with potential multisystemic involvement. Mesenteric panniculitis (MP) has been described as a rare feature in patients with SLE. The authors present a case of a 26 years old patient with previous diagnosis of SLE presenting with abdominal pain and distension and a peri-umbilical mass. Imagological findings were compatible with MP and ganglion biopsy revealed inflammatory pattern. Corticosteroid therapy was initiated with a resolution of pain after 6 months of treatment, with image reevaluation showing improvement of previous findings.

Scandinavian Journal of Rheumatology, Jun 6, 2022

UCL Discovery (University College London), Sep 2, 2017

axSpA patients with different gender, age, disease duration, and educational background. Results:... more axSpA patients with different gender, age, disease duration, and educational background. Results: Minor difficulties arose from the translation process of the ASAS-HI. The EF Item Set offered more difficulties indicating that concepts underlying the contextual factors may be more culture-dependent. A total of 10 patients with axSpA [8 males, mean age of 41.4 (±13.7)] participated in the field test. Cognitive debriefing showed that items of the ASAS-HI and EF Item Set of the Portuguese version are clear, relevant, understandable and easy to complete. As a result of cognitive debriefing, the wording of four items had to be changed to avoid misunderstandings or unintended interpretations, and a new response option "not applicable" was added to two items of the ASAS-HI to improve appropriateness. Conclusions: The resulting Portuguese version of the ASAS-HI and ASAS-EF showed acceptable linguistic validity and has potential for use in both clinical practice and research settings. Nevertheless, before European Portuguese versions can be fully implemented, its psychometric properties (validity and reliability) need to be evaluated.

analyses to search for baseline factors of work impact at 1-2 years (including a medium/high ASWI... more analyses to search for baseline factors of work impact at 1-2 years (including a medium/high ASWIS score, gender, age, schooling level, BASDAI, BASFI). Results: Among the 188 patients who answered the first questionnaire, 144 were currently working and were asked to answer the second questionnaire. A total of 101 patients answered both questionnaires. Mean age at inclusion was 45 (SD 9) years, 52% were male, disease duration was 14 (SD 8) years and 62% had an education level equivalent to more than high school. The BASDAI and the BASFI were respectively 34 (SD 21) and 23 (SD 23). At baseline, median ASWIS was 10, a low-risk score was found in 55 patients (54%), and a medium/high risk score in 46 (46%). 1-2 years later, 37 patients (36%) had work impact: 25 patients (25%) a short-term sick leave, and 12 patients (12%) a significant work impact (long-term disability or unemployment due to Ax-SpA). Among patients with a low ASWIS score at baseline (n=55), only 13 (24%) had a work impact (including only 2 with a significant impact). Among patients with a medium/high ASWIS score (n=46), 24 (52%) had a work impact (including 10 patients of a significant impact). In univariate analysis, baseline factors associated with work impact (moderate or significant) were a medium/high ASWIS score, a high BASFI and a shorter disease duration. In multivariate analysis, medium/high ASWIS (odds ratio, OR 2.71 (1.04-7.22)) and a lower disease duration (0.94 (0.89-0.99)) were independent predictive factors of work impact. Conclusions: In patients with axSpA, a medium/high ASWIS score was followed by a work impact in 50% of cases within 2 years in this well-controlled population. This short questionnaire can be helpful to screen for future difficulties at work, whatever the stage of disease. References: [1] Gilworth G, et al. Reducing work disability in ankylosing spondylitis: development of a work instability scale for AS.

PubMed, Mar 27, 2022

Sjogren's syndrome (SS) is an autoimmune pathology which mainly affects salivary and lacrimal gla... more Sjogren's syndrome (SS) is an autoimmune pathology which mainly affects salivary and lacrimal glands. Cerebellar degeneration association with SS is very rare, with only a few cases described. The treatment of SS with central nervous system involvement is not consensual. We present a 48-year-old woman with dysarthria, diplopia and ataxia associated with xerostomia. The brain magnetic imaging revealed bilateral cerebellar atrophy. She had antibody positivity for anti-SSA and anti-SSB and minor salivary glands biopsy revealed lymphocytic infiltration. Methylprednisolone, cyclophosphamide and intravenous immunoglobulin yielded no results. Rituximab was initiated with improvement in dysarthria and coordination.

Revue du Rhumatisme, Dec 1, 2020

Artificial intelligence (AI) systems too complex for predefined environment models and actions wi... more Artificial intelligence (AI) systems too complex for predefined environment models and actions will need to learn environment models and to choose actions that optimize some criteria. Several authors have described mechanisms by which such complex systems may behave in ways not intended in their designs. This paper describes ways to avoid such unintended behavior. For hypothesized powerful AI systems that may pose a threat to humans, this paper proposes a two-stage agent architecture that avoids some known types of unintended behavior. For the first stage of the architecture this paper shows that the most probable finite stochastic program to model a finite history is finitely computable, and that there is an agent that makes such a computation without any unintended instrumental actions.

Revue du Rhumatisme, Dec 1, 2021

Annals of the Rheumatic Diseases, Jun 1, 2014

Background: The foot is one of the most complex components of musculoskeletal system, and also on... more Background: The foot is one of the most complex components of musculoskeletal system, and also one of the less addressed in literature. However, its importance in daily activities (gait, posture, etc) has led to a growing concern in understanding the functional mechanisms and joint kinetics of the foot. Foot involvement, whether articular or enthesopatic, is well known in axial spondyloarthritis (aSpa) and peripheral spondyloartrhritis (pSpa). However, data on literature are scarce, and the true impact in patients is unknown. Objectives: To determine the prevalence of functional impairment of the foot and tibiotarsal joint in a cohort of patients with aSpa and pSpa and its relation with disease duration, activity and function indexes. Methods: Cross sectional study. Analyzed variables: gender, age and disease duration. Every patient answered the FAOS (Foot and Ankle Outcome Score) questionnaire, which assesses pain, functional aspects of the foot and tibiotarsal joint and its impact on quality of life and daily activities. In patients with aSpa, BASDAI and BASFI were obtained, as well as DAS28 in patients with pSpa. Control group: healthy individuals, adjusted by gender and age to patients. Statistical analysis with SPSS ® version 18.0 Results: Eighty patients were enrolled (38 with aSpa and 42 with pSpa), 50 males and 30 females; mean age was 47.3±14.24 years old and mean disease duration was 8.96±10.02 years. Mean DAS28 was 2.49±1.08, mean BASFI was 3.67±2.55 and mean BASDAI was 4.35±2.32. Mean FAOS was 85.5±11.1 on aSpa (mild symptoms) and 77.6±16.1 on pSpa (mild to moderate symptoms). Compared to control group, pSpa patients had lower FAOS values (p<0.03); this difference wasn't statistically significant with aSpa patients. Although lower FAOS values were found in females and older patients, this difference wasn't statistically significant. A statistically significant negative correlation was found between FAOS values and disease duration in pSpa patients (p<0.03). A statistically significant negative correlation was also found between disease activity and FAOS values (p<0.04 in aSpa and p<0.02, in pSpa); BASFI values also correlated negatively with FAOS (p<0.04). Conclusions: In our cohort, most of patients assumed the presence of mild to moderate functional impairment, especially those with pSpa, as expected. Foot involvement seems to relate directly with disease activity, in both aSpa and pSpa, and with disease duration in pSpa.

Annals of the Rheumatic Diseases, Jun 1, 2013

Methods: 77 post-menopausal women older than 65, having osteoporosis, have been analyzed. Upon co... more Methods: 77 post-menopausal women older than 65, having osteoporosis, have been analyzed. Upon completed densitometry examination of lumbosacral part of the spine (LS) L1-L4 and the hip, which helped identification of osteoporosis, X-ray test of the Th4-L5 portion of the spine was made for all the patients, aimed at detecting vertebral fractures, AP and profile, which have been analyzed by semi-quantitative method (Genant,1993); the analysis was made by a radiologist. Patients were treated with weekly (82%),monthly(13%) and intravenous(5%) bisfosfonates, 5600 weekly vitamin D3 supplementation and calcium carbonate 500 IU daily. During three years of treatment, follow up was done for vertebral fractures, any new fractures and BMD changes. Results: Average age of the patients ranged between 70,4±6,8 years, at the beginning, and average age at the end of study ranged between 73±7,2 years. BMI 24.4±5.9kg/m2, at the end 22± kg/m2, height 155.8±4.5cm, at the end 154±3,2, menopause started 18.9±5.4 years ago. Vertebral fractures were found out in 21 patients(27.27%). Symptomatic fractures were reported by 4 (19.04%)5,1%, patients whereas 17(80.95%)22,1% patients had the asymptomatic ones. One fracture was registered with 11 (53%) patients, 2 fractures with 6 (29%), and 3 and more with 4 (19%) patients. 1st degree fractures, according to Genant, were found out in 12 (57%), 2nd degree fractures were registered with 8 (38%) patients and 3rd degree fractures with 1(5%) patient. Study was finished after three years, and same diagnostic procedures were made(RTG, DXA). On follow up there were 71 (92,2%)patients, one developed colon carcinoma(1,2%), 2 died from cardiovascular death (2,5), and 3 left study due to gastrointestinal reasons 3,8%. Since it concerns fractures, one had fracture of femur (1,3%), two (2,7%) fractures of radius loco typico, and there were no new vertebral fractures. New fractures occurred in a group which did not have registered vertebral fractures at the beginning of the study. Increase of BMD and Tscore was noticed.The folow up is statistically significant in regard to the beginning on LS 6%, on hip 4% P<0,01,. Conclusions: The results obtained from research indicate a high percentage of asymptomatic vertebral fractures in the examined group of elderly postmenopausal women having osteoporosis. After three years of treatment with bisfosfonates they had low percent of new fractures, there was increase of BMD registered, no new vertebral fractures, and three new non-vertebral fractures.

African journal of thoracic and critical care medicine, Dec 19, 2022

Background. Hypersensitivity pneumonitis (HP) is a syndrome caused by sensitisation to inhaled an... more Background. Hypersensitivity pneumonitis (HP) is a syndrome caused by sensitisation to inhaled antigens that leads to an abnormal immune response in the airways and lung parenchyma. Some patients previously diagnosed with certain types of fibrotic interstitial lung diseases (f-ILDs), including fibrotic HP (f-HP), are susceptible to develop a progressive fibrosing phenotype (PF-ILD), despite initial stateof-the-art management. Objectives. To characterise a cohort of patients with a multidisciplinary diagnosis (MTD) of chronic f-HP, who were followed up in an ILD outpatient clinic of a hospital in Portugal, and to assess the prevalence of PF-ILD criteria in these patients. Methods. Data were collected from all patients with a definite or provisional diagnosis of f-HP after a multidisciplinary team discussion. Patients were followed up between December 2014 and July 2019. Data included clinical characteristics, high-resolution chest tomography (HRCT) disease patterns, lung function tests, bronchoalveolar lavage and further immunological work-up, biopsy reports (conventional transbronchial lung biopsy, transbronchial lung cryobiopsy or surgical video-assisted thoracoscopic lung biopsy), all ILD multidisciplinary team records and diagnostic confidence levels. Patients were assessed according to PF-ILD criteria as defined in the INBUILD trial. Results. We identified 83 patients with an MTD of HP, who had been followed up for at least 12 months. Of these, 63 (75.9%) were diagnosed with f-HP. Of the 63 f-HP patients, 33.3% (n=21) fulfilled the predefined criteria for PF-HP: 66.7% had a relative decline of ≥10% forced vital capacity (FVC); 5% a relative decline of 5-9% FVC, with worsening symptoms or increased fibrosis on HRCT; and 23.8% had worsening respiratory symptoms with radiological progression. Conclusion. This single-centre cohort study demonstrated that a third of f-HP patients presented with PF-ILD, as determined by progression during initial standard-of-care treatment. A usual interstitial pneumonia (UIP)/UIP-like pattern was present in >70% of patients with f-HP, and two-thirds of these patients had an FVC decline of ≥10%. PF-HP patients were also more exacerbation prone. According to recent trial data, this segment of patients can be considered possible candidates for antifibrotic treatment, with a reasonable prospect of effectiveness. Further efforts should focus on refining knowledge of longitudinal behaviour of large multicentric cohorts of f-HP patients, establishing a consensual and uniform definition of progression for use in clinical practice, as well as developing prognostic prediction tools to better (and early) inform the disease course.

ARP rheumatology, Oct 16, 2022

Sjogren's syndrome (SS) is an autoimmune pathology which mainly affects salivary and lacrimal gla... more Sjogren's syndrome (SS) is an autoimmune pathology which mainly affects salivary and lacrimal glands. Cerebellar degeneration association with SS is very rare, with only a few cases described. The treatment of SS with central nervous system involvement is not consensual. We present a 48-year-old woman with dysarthria, diplopia and ataxia associated with xerostomia. The brain magnetic imaging revealed bilateral cerebellar atrophy. She had antibody positivity for anti-SSA and anti-SSB and minor salivary glands biopsy revealed lymphocytic infiltration. Methylprednisolone, cyclophosphamide and intravenous immunoglobulin yielded no results. Rituximab was initiated with improvement in dysarthria and coordination.

OBJECTIVE: The Assessments of SpondyloArthritis international Society Health Index (ASAS HI), est... more OBJECTIVE: The Assessments of SpondyloArthritis international Society Health Index (ASAS HI), estimates the impact of Spondyloarthritis (SpA) on global functioning and health. This article assesses the construct validity, reliability and responsiveness of the Portuguese version of the ASAS HI. PATIENTS AND METHODS: Patients fulfilling ASAS classification criteria for axial (axSpA) or peripheral SpA (pSpA) were included. Construct validity was assessed through Spearman's correlation analysis with other health outcomes. Discriminant validity was tested comparing the ASAS HI across disease activity and functional states using the Kruskal-Wallis test. Internal consistency was assessed by Cronbach's α, and test-retest reliability by intraclass correlation coefficients (ICC). Responsiveness was evaluated by the standardized response mean (SRM) in patients with active disease who required therapy escalation. RESULTS: Among the 91 patients included, 67% were male, mean (SD) age 47.2...

International Journal of Rheumatic Diseases

Annals of the Rheumatic Diseases

BackgroundAnti-Ro/SSA antibodies are directed against different proteins of intracellular small r... more BackgroundAnti-Ro/SSA antibodies are directed against different proteins of intracellular small ribonucleic acid (RNA)-protein complexes, Ro60 (60 kDa) and Ro52 (52 kDa) and are the most frequently detected autoantibodies in patients´ sera. The clinical associations with antibodies to the Ro60 protein is well documented and includes systemic lupus erythematosus (SLE) and Sjögren syndrome (SS). [1]The presence of anti-Ro52 antibodies has been reported in a large variety of diseases, such as neoplastic diseases or viral infections [1, 2].ObjectivesThe aim of this study was to analyze the clinical relevance and the disease phenotype of patients with anti-Ro52 and/or anti-Ro60 autoantibodies in a single portuguese tertehospital.MethodsRetrospective and descriptive study included all patients screened for anti-nuclear antibodies (ANA) in the database of the immunology laboratory of our Hospital between 2017 and 2021. Only adult patients (≥ 18-years-old) with positive anti-Ro52 and/or Ro6...

Annals of the Rheumatic Diseases

BackgroundInterstitial lung diseases (ILDs) are a group of heterogeneous lung disorders with vari... more BackgroundInterstitial lung diseases (ILDs) are a group of heterogeneous lung disorders with variable prognosis. Idiopathic pulmonary fibrosis (IPF) is the main idiopathic interstitial pneumonia and rheumatoid arthritis (RA) is the commonest cause of connective tissue disease related-ILD. In fact, ILD is the most frequent form of respiratory involvement in RA, with 10% patients having clinically significant disease, frequently imposing significant morbi-mortality. RA-ILD can potentially comprise different disease patterns with distinct prognosis, with usual interstitial pneumonia (UIP) being the most frequent radio-histological pattern. Several studies have suggested that the RA-UIP disease course and survival may be clinically similar to IPF.ObjectivesThis study aimed to investigate comparative clinical features, longitudinal behaviour and healthcare resource utilization between local cohorts of RA-UIP and IPF patients.MethodsRetrospective and descriptive study including all IPF an...

Annals of the Rheumatic Diseases, 2013

Background The impact of rheumatic diseases on patients’ sexuality has been, for a long time, an ... more Background The impact of rheumatic diseases on patients’ sexuality has been, for a long time, an ignored topic. As quality of life in these patients became more valorized, sexuality, as a major aspect for the individual’s well being, arised as a subject to be considered over the last decade1. The awareness of the physicians for the problem is of great importance, since the impact in sexual life might be a major concern and still, a quite uncomfortable topic for the patient – both with healthcare professionals and partners. Objectives To analyze the approach by the healthcare service and/or partners on the patients’ perspective of the impact of the rheumatic disease in their sexual activity. Methods An anonymous questionnaire was performed, consisting in demographic data (sex, age, disease duration, civil status, professional status and educational level), and questions related to the importance attributed to sexual activity, as well as to the approach of the topic by the patient and healthcare professionals, with multiple choice questions and questions to be answered through a visual analogical scale. A descriptive study was performed. Results 95 patients with the diagnosis of spondyloarthritis were enrolled and 76 answered the questionnaire; 31 had psoriatic arthritis, 30 had ankylosing spondylitis, 9 had undifferentiated spondyloarthritis and 6 had inflammatory bowel disease spondyloarthritis; 40 were male, 35 were female and 1 unknown. Mean age was 46.08±12.08 and mean disease duration was 12.17±10.32 years. Most of patients were married (56) or common law married (8); 19 patients had completed primary school only and less than one quarter were graduate or higher. In a visual analogical scale, mean importance give to sexual capacity was 74.67±24.55. Among the 76 patients, only 35 stated they talked about the subject with their partner; however, the great majority (66 patients) said they had the partner’s understanding towards their limitations in sexual activity. The perception of conditioning in the conjugal relationship was, in a visual analogical scale, 33.68±31.56. 58 patients had never talked about it with anyone else and 65 had never been questioned by any health professional (rheumatologist, general practitioner or nurse). Conclusions This work emphasizes that the impact of spondyloarthritis on sexual activity is a topic rarely approached either by the patients, either by health professionals. Since patients valorize a lot their sexual capacity and seem not to talk about the limitations imposed by their disease, this subject might deserve a greater attention, including from rheumatologists and other healthcare professionals. References Helland Y, Kjeken I, Steen E, Kvien TK, Hauge MI, Dafinrud H. Rheumatic Diseases and Sexuality: Disease Impact and Self-Management Strategies. Arthritis Care & Res 2011;5:743–750 Disclosure of Interest None Declared

Annals of the Rheumatic Diseases, 2013

ABSTRACT Background The impact of rheumatic diseases on patients’ sexual life has been gathering ... more ABSTRACT Background The impact of rheumatic diseases on patients’ sexual life has been gathering the attention of the scientific community over the last decade1. However, specific assessemnt tools are scarce and there are few existing studies, specially those related to spondyloarthritis2 and particularly to psoriatic arthritis. In fact, several factors may condition sexual function in these patients: pain, stiffness, decreased range of motion, joint swelling and extraarticular features such as fatigue, enthesopathy and, in the case of psoriatic arthritis, cutaneous lesions. Objectives To assess sexual satisfaction in a cohort of patients with spondyloarthritis; to identify the limitation imposed by different factors related to the disease in sexual activity; to search for relations between those limitation and quality of life and disease activity and function indexes. Methods An anonymous questionnaire was performed, consisting in two parts. One part consisted in a questionnaire filled by the physician with data on the disease – affected joints, extraarticular features, comorbidities, current treatment, metrology in patients with axial involvement, disease activity (BASDAI and/or DAS28) and function (BASFI and HAQ) indexes and quality of life index (ASQoL). The other part consisted in a questionnaire filled by the patient, with demographic data (sex, age, disease duration, civil status, professional status and educational level), multiple choice questions and questions to be answered through a visual analogical scale, including items approached in some validated indexes of sexual function and satisfaction assessment. Statistical treatment was performed using SPPS system, version 17.0. Results 95 patients with the diagnosis of spondyloarthritis were enrolled and 76 answered the questionnaire; 31 had psoriatic arthritis, 30 had ankylosing spondylitis, 9 had undifferentiated spondyloarthritis and 6 had inflammatory bowel disease spondyloarthritis; 40 were male, 35 were female and 1 unknown. Mean age was 46.08±12.08 and mean disease duration was 12.17±10.32 years. In a visual analogical scale, the mean sexual satisfaction level was 52.28±30.99; the perception of conditioning in the conjugal relationship was 33.68±31.56; limitation on sexual activity was 32.72±31.06; limitation by pain, joint swelling, fatigue, stiffness, decreased range of motion, decreased libido and psoriasis lesions varied from 29.17±28.51 (swelling) e 46.94±32.31 (fatigue), and there was no significant difference between sexes, diagnoses and type of involvement. A strong correlation was identified between most of these factors and ASQoL and HAQ values, but not between them and activity indexes. The presence of comorbidities did not influence the obtained values in a statistically significant way. Conclusions This work highlights the impact of spondyloarthritis on patients’ sexual function. Fatigue was mentioned as the most limiting factor in sexual activity, and the values obtained had a strong correlation with quality of life index in ankylosing spondylitis and with function index in psoriatic arthritis. The type of disease and joint involvement didn’t imply statistically significant differences on the analyzed parameters in this cohort of patients. Disclosure of Interest None Declared

Annals of the Rheumatic Diseases, 2015

Background: Pulmonary hypertension (PHT) may contribute to the cardiovascular (CV) morbidity in r... more Background: Pulmonary hypertension (PHT) may contribute to the cardiovascular (CV) morbidity in rheumatoid arthritis (RA); however understanding of its etiology in RA remains limited. PHT may be under-recognized in RA and may be associated with factors other than interstitial lung disease (ILD) as conventionally thought. 1 Objectives: To estimate the frequency of PHT in adult RA (age >18) and to study associations of PHT with ILD, left ventricular diastolic dysfunction (LVDD), left ventricular systolic dysfunction (LVSD) and valvular heart diseases (VHD). Methods: We identified adult RA patients with at least one transthoracic echo (TTE) performed between 1997 and 2014. The RA patients were required to have at least two visits with recorded International Classification of Disease, Ninth Revision (ICD9 code 714.0 and at least one prescription for a disease modifying anti-rheumatic drug. 2 PHT was defined as pulmonary artery systolic pressure (PASP) >35 mmHg on TTE. LVDD was defined as mild, moderate and severe as per established criteria based on mitral inflow velocities (MIV) (E and A) and lateral mitral annulus velocity (E') measured by Tissue Doppler Imaging (TDI). 3 LVSD was defined as LVEF <40%. Student's t test was used to compare continuous variables and chi-square test was used for categorical variables; p value of <0.05 was considered significant. Results: Total 187 patients satisfied inclusion criteria, of which 67 (35.8%) patients had PHT. Age, sex, race and ethnicity were not significantly different between patients with and without PHT (Table). Patients with PHT had higher frequencies of coronary artery disease, peripheral arterial disease, and chronic kidney disease; although total comorbidities were not significantly different between the groups. Isolated LVDD was the most common association of PHT found in 22 (32.8%) of cases. Severe LVDD (E/A ≥1.5) was more prevalent in patients with PHT (22.3%) as compared to without PHT (6.7%). Other associations included LVSD in 10 (14.9%) cases, LVDD plus LVSD in 7 (10.4%) cases and aortic stenosis in 3 cases (4.5%). Eleven (16.41%) patients had ILD; of which 5 patients had ILD along with LVSD, LVDD or both. No differences in frequency of ILD were found between patients with and without PHT (12.5% v/s 16.4%). Conclusions: We found that PHT was present in over one third of RA patients who had a TEE performed at our center. CV comorbidities and LVDD were the most common associations. Severe LVDD was more frequent in patients with PHT. Although limited by its retrospective design and PHT definition by TTE, this is one of the largest studies to date looking at the frequency and the association between PHT and LVDD in RA. The strengths of the study include a well-defined study population and use of more accurate measures (MIV and TDI) to define LVDD. Enhanced recognition and early intervention of CV risk factors may prevent development and progression of PHT in RA patients. References: [1] O'Dwyer DN, et al. Rheumatoid Arthritis associated interstitial lung disease.

Annals of the Rheumatic Diseases, 2013

ABSTRACT Background The loss of muscle mass (MM) is a serious problem which may cause serious ill... more ABSTRACT Background The loss of muscle mass (MM) is a serious problem which may cause serious illness and premature death. Several studies show that about two-thirds of Rheumatoid Arthritis (RA) patient’s have loss of MM, known as Rheumatoid Cachexia. Many factors were identified in the pathogenesis of this process: excessive production of cytokines TNF-α, low physical activity and reduction of the peripheral action of insulin. It is known that RA patients have higher rates of proteins degradation and it is thought that the TNF-α stimulates muscle catabolism, been described as a “sarcoactive” cytokine. The elevation of pro-inflammatory cytokines is also present in spondyloarthritis (Spa) so, like in RA, loss of MM may occur. There are few studies about the association between loss of MM and Spa and the results are discrepant so, the effect of chronic inflammation and disease activity in body composition is still unknown. Objectives Assess muscle mass index (MMI) in patients with Spa; verify if they have higher risk of sarcopenia and if the MMI is related with disease activity, functional impairment and duration of the illness. Methods Case-control study, in a population of patients with Spa (axial or peripheral). The control group were users of a Family Health Unit. Variables: sex; age; height; weight, duration of disease, pathological antecedents, chronic medication, MMI, disease activity (BASDAI and/or DAS28); BASFI and HAQ. The MMI was determinated, from the value of MM, using Lee’s equation. Results A sample of 60 patients was obtained; 52% were female. The average age was 45.5 years (± 13.4), and the average duration of the disease 10.9 years (± 11.6), 40% of patients met criteria for psoriatic arthritis (PsA). According to the classification of the MMI, 62% of the patients had sarcopenia. There was a statistically significant difference between MMI of the Spa group and the control group (7.12 ± 0.99 vs. 7.8 ± 0.93; p &lt; 0.05). The Odds ratio between cases and controls with and without sarcopenia was 2.1. In the group of patients with ankylosing spondylitis no association was found between MMI and BASFI, BASDAI, or duration of the disease. However, in the subgroup of patients with PsA with axial involvement, a very strong negative correlation was found between MMI and the BASFI (rho =- 0.823; p &lt; 0.05). Sex, concomitant medication and pathological history doesn’t seem to influence the degree of sarcopenia. Conclusions This study shows that the risk of sarcopenia in Spa patients is twice than in the control group. It hasn’t possible to identify the factors associated with that loss of MM, with the exception of a small group of patients with axial PsA, where a worse functional capacity was related with higher levels of sarcopenia. The limitations of this study were: use of a non validated equation to calculate MM, small number of the sample and the bias of measurement. Disclosure of Interest None Declared

Annals of the Rheumatic Diseases, 2013