Mirhelen Mendes de Abreu | Universidade Federal do Rio de Janeiro (UFRJ) (original) (raw)

Papers by Mirhelen Mendes de Abreu

Annals of the Rheumatic Diseases, Jun 1, 2015

Conclusions: The MetS, which is a constellation of vascular risk factors, was significantly assoc... more Conclusions: The MetS, which is a constellation of vascular risk factors, was significantly associated with coronary and peripheral arterial events in patients with SLE. Moreover, the presence of the MetS within 5 years of latest follow-up was associated with mortality and the occurrence of ESRF.

A febre chikungunya tem se tornado um importante problema de saúde pública nos países onde ocorre... more A febre chikungunya tem se tornado um importante problema de saúde pública nos países onde ocorrem as epidemias, visto que metade dos casos evolui com artrite crônica, persistente e incapacitante. Os dados na literatura sobre terapêuticas específicas nas diversas fases da artropatia ocasionada pela infecção pelo vírus chikungunya (CHIKV) são limitados, não existem estudos randomizados de qualidade que avaliem a eficácia das diferentes terapias. Há algumas poucas publicaç ões sobre o tratamento das manifestaç ões musculoesqueléticas da febre chikungunya, porém com importantes limitaç ões metodológicas. Os dados atualmente disponíveis não permitem conclusões favoráveis ou contrárias a terapêuticas específicas, bem como uma adequada avaliação quanto à superioridade entre as diferentes medicaç ões empregadas. O objetivo deste trabalho foi elaborar recomendaç ões para o tratamento da febre chikungunya no Brasil. Foi feita uma revisão da literatura com seleção de artigos baseados em evidência, nas bases de dados Medline, SciELO, PubMed e Embase e de resumos de anais de congressos, além da opinião dos especialistas para dar apoio às decisões tomadas para definir as recomendaç ões. Para a definição do grau de concordância foi feita uma metodologia Delphi, em duas reuniões presenciais e várias rodadas de votação on line. Este artigo refere-se à parte 2 das Recomendaç ões da Sociedade Brasileira de Reumatologia para Diagnóstico e Tratamento da Febre Chikungunya, que trata especificamente do tratamento.

Arthritis Care and Research, Apr 12, 2018

Objectives-To assess hepatitis B (HBV) reactivation rates in patients with resolved or chronic HB... more Objectives-To assess hepatitis B (HBV) reactivation rates in patients with resolved or chronic HBV infection, receiving Disease Modifying Anti-Rheumatic Drugs (DMARDs) and with or without antiviral prophylaxis. Methods-We conducted a systematic review and meta-analysis. Electronic searches were conducted in Pubmed, Medline and EMBASE using OVID through 12/31/2015. A search strategy was developed for each database using the following inclusion criteria: participants (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, resolved, or chronic HBV infection), interventions (TNF inhibitors, non-TNF biologic or non-biologic DMARDs), and outcomes (hepatitis B reactivation). Four reviewers independently extracted study data and assessed study quality with the Newcastle-Ottawa scales. To determine the pooled hepatitis B reactivation rate, the variances of the raw proportions were stabilized using a Freeman-Tukey-type arcsine square root transformation, using a random-effects model. Results-Twenty-five studies met the inclusion criteria. The overall pooled rate of hepatitis B reactivation was 1.6% (95% CI, 0.8-2.6%) in patients with resolved hepatitis B. Similar rates were observed in resolved patients on TNF inhibitors (1.

quarter. Related to the diagnosis, it was observed that 34% of the patients reported a feeling of... more quarter. Related to the diagnosis, it was observed that 34% of the patients reported a feeling of anxiety, surprise, fright and fear; 27% reported feelings of abandon and helplessness when faced with becoming ill; 24% expected the diagnosis due to previous pregnancies, albeit with negative feelings, and; 15% were not able to express in words the feelings that had been triggered. As for the fetal repercussions of the diagnosis, 55% expressed fear of fetal malformation, 35% feared prematurity and 10% did not relate any fetal repercussion to it. Related to the hospitalization, it was observed that 64% reported negative sentiments (anguish, increased anxiety, fear and sadness, restricted eating) and 36% described hospitalization with positive feelings (support, protection and care). Conclusion The high-risk pregnancy may trigger a disorganization of thoughts and feelings, intensifying anxieties, fears and negative beliefs. As for hospitalization, more than half of the cohort presents negative feelings, such as something threatening to the continuity of the gestation. The increase in anxiety also stems from the necessity of getting accustomed to the controlled hospital diet. However, a considerable percentage understands hospitalization as protective, nurturing feelings of emotional continence and support.

Annals of the Rheumatic Diseases, Jun 1, 2013

Background: Shared decision making (SDM) has been advocated as the preferred form of decision mak... more Background: Shared decision making (SDM) has been advocated as the preferred form of decision making over the past two decades. Literature has shown discrepancies among all health stakeholders' understanding about shared-decision making concept. Objectives: Evaluate primary care patients' understanding of SDM concept in a Brazilian town and describe their willingness to be involved in their own healthcare plan. Also, examine patients' opinion regarding the role of multiprofessional team in the quality of care. Methods: This is a quantitative study. All patients registered in a primary care unit were asked to participate. A questionnaire covering demographic and clinical data, and patients opinions regarding the role of the multiprofessional team on the quality of care was applied. Three scenarios that presented different models of clinical encounter (paternalistic, informed and shared decision making) were presented. Outcome measures were the answers from the questionnaire and the answers regarding the scenarios. Statistical analysis was performed through measures of central tendency and dispersion. The associations among the categories were conducted by correspondence analyses (multivariate analysis). This study was approved by Research Ethics Committee. Results: We interviewed 278 patients, 50% Caucasian, 79% female, 24% between 20 and 29 years old and 42% with incomplete primary education. 78% of the respondents consider that multidisciplinary work team is important to improve patient's knowledge regarding the disease they had. When asked about patient's involvement in the health plan decisions, 78.4% prefer to decide about the treatment with the doctor. Despite of this result, when asked about the meaning of SDM, paternalistic and informed decision-making, 83% defined SDM and informed decision making as similar concepts. A correspondence analysis plot illustrated that females, mestizos, and aged between 30 and 39 year olds were associated with more willingness to share the decisions with the physician. There was no association between comprehension about decisionmaking and having a chronic disease. Conclusions: The level of understanding of the difference between informed, shared and paternalistic decision-making is not clear from this sample. This study demonstrated that patients in primary care consider that a multiprofessional teamwork is significant to improve patient's knowledge regarding their disease. References: 1. Abreu, MM; Gafni, A; Ferraz, MB. Development and testing of a decision board to help clinicians present treatment options to lupus nephritis patients in Brazil.

Journal of Bone and Mineral Research

ABSTRACTIn this international study, we examined the incidence of hip fractures, postfracture tre... more ABSTRACTIn this international study, we examined the incidence of hip fractures, postfracture treatment, and all‐cause mortality following hip fractures, based on demographics, geography, and calendar year. We used patient‐level healthcare data from 19 countries and regions to identify patients aged 50 years and older hospitalized with a hip fracture from 2005 to 2018. The age‐ and sex‐standardized incidence rates of hip fractures, post‐hip fracture treatment (defined as the proportion of patients receiving anti‐osteoporosis medication with various mechanisms of action [bisphosphonates, denosumab, raloxifene, strontium ranelate, or teriparatide] following a hip fracture), and the all‐cause mortality rates after hip fractures were estimated using a standardized protocol and common data model. The number of hip fractures in 2050 was projected based on trends in the incidence and estimated future population demographics. In total, 4,115,046 hip fractures were identified from 20 databas...

Advances in Rheumatology, 2021

Background There is a lack of information on the role of chronic use of hydroxychloroquine during... more Background There is a lack of information on the role of chronic use of hydroxychloroquine during the SARS-CoV-2 outbreak. Our aim was to compare the occurrence of COVID-19 between rheumatic disease patients on hydroxychloroquine with individuals from the same household not taking the drug during the first 8 weeks of community viral transmission in Brazil. Methods This baseline cross-sectional analysis is part of a 24-week observational multi-center study involving 22 Brazilian academic outpatient centers. All information regarding COVID-19 symptoms, epidemiological, clinical, and demographic data were recorded on a specific web-based platform using telephone calls from physicians and medical students. COVID-19 was defined according to the Brazilian Ministry of Health (BMH) criteria. Mann–Whitney, Chi-square and Exact Fisher tests were used for statistical analysis and two binary Final Logistic Regression Model by Wald test were developed using a backward-stepwise method for the pre...

Anais do Congresso Brasileiro de Reumatologia 2020, 2021

BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has caused restrictive measures, incl... more BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has caused restrictive measures, including suspension of face-to-face lectures, clerkship and internship in medical schools. Additionally, medical students were invited to participate on the front-lines against the COVID-19, which may have had negative impacts on students' mental health. The Mario Pinotti II study (MPII) is a multicenter study carried out to evaluate if hydroxychloroquine could have some protective role regarding moderate-severe forms of SARS-CoV-2 infection in patients with rheumatic diseases. Medical students were trained as voluntary evaluators to collect patient data during 24 weeks of follow-up. The aim of this study is to evaluate the effect of participation in MPII on medical students' mental health. MATERIALS AND METHODS This is a cross-sectional web survey designed to evaluate medical students participating in MPII, assigned as the volunteer group (VG), and their colleagues who were not involved in this project (control group [CG]), matched by sex and medical school (public and private background). The questionnaire was developed by the researchers and addressed demographic data, lifestyle habits, and participants' opinions about the MPII and the impact of the COVID-19 pandemic on their medical training routine. The domains of depression, anxiety and stress were assessed using the Brazilian version of the Depression, Anxiety and Stress Scale (DASS-21), which scores estimate the risk for mental suffering. Data collection was carried out from 20th July to 31st August 2020. The SPSS version 20.0 statistical package was used in all analyzes and a p-value of less than 0.05 was considered statistically significant. RESULTS A total of 684 medical students were included in our sample, 228 as VG and 456 as CG. Median age was 23 years (IQ 21-24) and the CG were older than the VG (p < 0.03). The majority of them were white (69%, self-reported), women (63%) and single marital status (97%). There was no significant difference regarding comorbidities, ethnicity, smoking status, alcohol use, physical activity and self-reported previous anxiety and depression. The DASS-21 scores presented significantly lower values in VG 12(0-56) than CG 15(0-61) (p = 0.001). CONCLUSION The participation of medical students in MPII study allowed social interaction with patients, colleagues, professors and medical assistants during COVID-19 pandemic, favoring higher inter-person engagement and better mental health status.

Blucher Medical Proceedings, 2019

BACKGROUND Vessel imaging in Takayasu arteritis (TA) is often performed in clinical practice foll... more BACKGROUND Vessel imaging in Takayasu arteritis (TA) is often performed in clinical practice following clinical symptoms such as limb claudication. Conversely, the correlation between limb claudication and vessel imaging manifestations has not been assessed.

Anais do Congresso Brasileiro de Reumatologia 2020, 2021

BACKGROUND Although several randomized clinical trials have demonstrated no evidence of using hyd... more BACKGROUND Although several randomized clinical trials have demonstrated no evidence of using hydroxychloroquine (HCQ) to manage patients with coronavirus disease 2019 (COVID-19), including mild, moderate and severe forms, as well as pre-and postexposition, there are still controversies regarding to patients who use it chronically, such as those with rheumatic diseases (RD). The aim of this work was to compare the incidence of hospitalization and the mortality rate related to suggestive COVID-19 between RD patients on HCQ and their household during 16-week follow-up. MATERIALS AND METHODS Adult RD patients on HCQ for at least 30 days prior to baseline were compared with adult's household cohabitants (no RD and not using antimalarials). Information regarding epidemiological, clinical data, COVID-19 symptoms, and hospitalizations were collected through every other week phone calls performed by physicians and medical students. The data were recorded on a specific web-based platform. All participants who completed the last study visit (from baseline to V6; during 16 weeks) were included in this analysis. A significant p-value was set as < 0.05. RESULTS Considering a total of 9,589 participants included at baseline, 5,574 (58.1%) of them completed the V6, of whom 3,473 RD patients. The clinical and epidemiological characterization at baseline were presented in other submission. Symptoms Realização Promoção

Advances in rheumatology, Mar 15, 2023

Clinical practice guidelines (CPG) are developed to align standards of health care around the wor... more Clinical practice guidelines (CPG) are developed to align standards of health care around the world, aiming to reduce the incidence of misconducts and enabling more effective use of health resources. Considering the complexity, cost, and time involved in formulating CPG, strategies should be used to facilitate and guide authors through each step of this process. The main objective of this document is to present a methodological guide prepared by the Epidemiology Committee of the Brazilian Society of Rheumatology for the elaboration of CPG in rheumatology. Through an extensive review of the literature, this study compiles the main practical recommendations regarding the following steps of CPG drafting: distribution of working groups, development of the research question, search, identification and selection of relevant studies, evidence synthesis and quality assessment of the body of evidence, the Delphi methodology for consensus achievement, presentation and dissemination of the recommendations, CPG quality assessment and updating. This methodological guide serves as an important tool for rheumatologists to develop reliable and high-quality CPG, standardizing clinical practices worldwide.

Annals of the Rheumatic Diseases, May 19, 2021

Conclusion: The innovative US teaching concept was able to demonstrate, that it is appropriate fo... more Conclusion: The innovative US teaching concept was able to demonstrate, that it is appropriate for the training of dermatologists in MSUS, independently of their age, experience in dermatology and US.

Annals of the Rheumatic Diseases, May 19, 2021

Objectives: In patients with rheumatic and musculoskeletal diseases (RMDs) and infected with Covi... more Objectives: In patients with rheumatic and musculoskeletal diseases (RMDs) and infected with Covid-19, we aim to investigate the role of systemic autoimmune conditions compared to other type of RMDs in severity of COVID-19 in terms of hospital admissions. Methods: An observational longitudinal study was conducted during the epidemic peak in Madrid (1 st Mar to 20 th May2020). All patients attended at the rheumatology outpatient clinic of a tertiary hospital with a diagnosis of RMDs and Covid-19 infection were included (according to a medical diagnosis or confirmed with a positive SARS-CoV-2 PCR diagnostic test). All patients were included since the time of COVID-19 diagnosis. Main variable: hospital admission related to Covid-19 infection. Independent variable: type of RMD including: autoimmune (systemic autoimmune conditions and inflammatory joint disease (IJD)) and nonautoimmune (mechanical diseases, and inflammatory diseases (microcrystalline arthritis and tendonitis)). Covariates: sociodemographic, clinical and therapy used. Statistical analysis: description of the sociodemographic, clinical and treatment characteristics of the patients. A multivariate logistic regression adjusted by age, sex and comorbidities was used to evaluate the risk of the different types of RMDs in hospital admissions related to Covid-19. The results were expressed as OR with its corresponding confidence interval (95% CI). Results: 406 patients were included with RMDs and Covid-19 infection. 69.21% were women with a mean age at diagnosis of 60 ± 15.26 years. The evolution time from the diagnosis of RMD was 8 ± 8.38 years. 26% had comorbidity at baseline. 25% were chronically on corticoids prior to the infection. Of the 406 patients, 244 (60.09%) had non-autoimmune RMD (157 mechanic, 87 inflammatory) and 162 (39.9%) (106 (65.43%) IJD, 56 (34.56%) systemic autoimmune condition) had autoimmune RMD. 36% of all patients were admitted (31% from not autoimmune RMDs and 43% from autoimmune RMD (p = 0,013). The risk of hospital admission in autoimmune RMD compared to non-autoimmune RMD was higher (OR: 1.68; [1.11-2.54], p=0.013), being the risk of systemic autoimmune condition compared to both IJD and non-autoimmune RMD higher (OR

Annals of the Rheumatic Diseases, May 19, 2021

Background: SLE disease activity tools do not optimally define disease activity and response. The... more Background: SLE disease activity tools do not optimally define disease activity and response. The SLEDAI arthritis item is common, and sufficient to define SRI response. Lupus patients with arthralgia often have no swelling. Glossary definitions of arthritis in different versions of the SLEDAI have included: swelling, swelling between visits, effusion, tenderness, warmth and erythema. MSK ultrasound in SLE can identify synovitis without swelling, ultrasound synovitis is associated with worse symptoms and serology, predicts response to therapy, and is more responsive to therapy than clinical variables. Objectives: To validate different glossary definitions for SLEDAI arthritis using musculoskeletal ultrasound. Methods: We analysed baseline data from a multicentre longitudinal study. Physicians scored SLEDAI-2K in 133 patients with joint pain that was considered inflammatory, but not necessarily swelling. Stable immunosuppressants and prednisolone <=5mg were permitted. If the arthritis criterion was scored, we asked physicians to report which glossary features drove their decision. Musculoskeletal ultrasound of hands and wrists was performed on the same day, blinded to clinical findings. We defined abnormal grey-scale in joints as 1 joint with GS>=2, and in tendons as >=1 tendon with GS >=1, and abnormal power Doppler as >=1 joint or tendon with PD >=1. Results: 78/133 patients had arthritis scored on SLEDAI-2K. In 21/78, swelling was not a reason for that decision. These 21 patients had either tenderness (16/21), swelling reported between visits (4/21) or both of these (1/21). No patient was scored for warmth, erythema or effusion alone. Comparison of SLEDAI definitions and ultrasound is shown in Table 1. Of 57 patients with SLEDAI arthritis scored due to swelling, 90% had an abnormal ultrasound. The positive predictive value was 89% (95% CI 79-94). Of 21 patients with SLEDAI arthritis scored without swelling, 48% had an abnormal ultrasound. The positive predictive value was 48% (95% CI 31-67). There was no substantive difference in clinical and serological variables comparing patients with SLEDAI arthritis without swelling and patients without SLEDAI arthritis. In contrast, patients with SLEDAI arthritis with swelling had worse ESR (p=0.0003), Physician MSK disease activity VAS (p<0.001) and patient EMS VAS (p=0.0019) and IgG (p=0.0625) compared to the other two groups. Conclusion: Although ultrasound proven synovitis in the absence of swelling is not uncommon, it is not reliably identified using other signs or symptoms. The arthritis item of the SLEDAI was likely to be associated with ultrasound synovitis if scored because of swelling, but not if scored because of tenderness or swelling between visits. Our results support raising the threshold criteria for arthritis so that it should only be scored when there is joint swelling. Previous clinical trial datasets could be re-analysed excluding SLEDAI arthritis scores not confirmed by a swollen joint count greater than one.

Revista Brasileira De Reumatologia, 2017

Revista Brasileira De Reumatologia, 2017

Clinical and experimental rheumatology, 2021

OBJECTIVES To evaluate the incidence of COVID-19 and its main outcomes in rheumatic disease (RD) ... more OBJECTIVES To evaluate the incidence of COVID-19 and its main outcomes in rheumatic disease (RD) patients on hydroxychloroquine (HCQ) compared to household cohabitants (HC). METHODS This is a 24-week nationwide prospective multi-centre cohort with a control group without RD and not using HCQ. All participants were monitored through scheduled phone interviews performed by health professionals. Details regarding COVID-19 symptoms, and epidemiological, clinical, and demographic data were recorded on a specific web-based platform. COVID-19 was defined according to the Brazilian Ministry of Health criteria and classified as mild, moderate or severe. RESULTS A total of 9,585 participants, 5,164 (53.9%) RD patients on HCQ and 4,421 (46.1%) HC were enrolled from March 29th, 2020 to September 30th, 2020, according to the eligibility criteria. COVID-19 confirmed cases were higher in RD patients than in cohabitants [728 (14.1%) vs. 427 (9.7%), p<0.001] in a 24-week follow-up. However, there...

Arquivos Brasileiros de Oftalmologia

Lupus retinopathy is a clinical manifestation of systemic lupus erythematosus in the visual syste... more Lupus retinopathy is a clinical manifestation of systemic lupus erythematosus in the visual system. It is generally asymptomatic; however, it can become a threatening condition. It is closely associated with the inflammatory activity and higher mortality of systemic lupus erythematosus. Lupus retinopathy has several different clinical presentations, such as lupus microangiopathy, vascular occlusion, vasculitis, hypertensive retinopathy associated with lupus nephritis, and autoimmune retinopathy. Although the prevalence and associated factors of lupus retinopathy have been well defined in some parts of the world, there are no data from Latin America, including Brazil. As lupus retinopathy is generally asymptomatic, without a routine fundoscopy, it has been probably underestimated. This review is intended to discuss the epidemiology and risk factors of lupus retinopathy.

BV UNIFESP: Teses e dissertaçõe

Annals of the Rheumatic Diseases, Jun 1, 2015

Conclusions: The MetS, which is a constellation of vascular risk factors, was significantly assoc... more Conclusions: The MetS, which is a constellation of vascular risk factors, was significantly associated with coronary and peripheral arterial events in patients with SLE. Moreover, the presence of the MetS within 5 years of latest follow-up was associated with mortality and the occurrence of ESRF.

A febre chikungunya tem se tornado um importante problema de saúde pública nos países onde ocorre... more A febre chikungunya tem se tornado um importante problema de saúde pública nos países onde ocorrem as epidemias, visto que metade dos casos evolui com artrite crônica, persistente e incapacitante. Os dados na literatura sobre terapêuticas específicas nas diversas fases da artropatia ocasionada pela infecção pelo vírus chikungunya (CHIKV) são limitados, não existem estudos randomizados de qualidade que avaliem a eficácia das diferentes terapias. Há algumas poucas publicaç ões sobre o tratamento das manifestaç ões musculoesqueléticas da febre chikungunya, porém com importantes limitaç ões metodológicas. Os dados atualmente disponíveis não permitem conclusões favoráveis ou contrárias a terapêuticas específicas, bem como uma adequada avaliação quanto à superioridade entre as diferentes medicaç ões empregadas. O objetivo deste trabalho foi elaborar recomendaç ões para o tratamento da febre chikungunya no Brasil. Foi feita uma revisão da literatura com seleção de artigos baseados em evidência, nas bases de dados Medline, SciELO, PubMed e Embase e de resumos de anais de congressos, além da opinião dos especialistas para dar apoio às decisões tomadas para definir as recomendaç ões. Para a definição do grau de concordância foi feita uma metodologia Delphi, em duas reuniões presenciais e várias rodadas de votação on line. Este artigo refere-se à parte 2 das Recomendaç ões da Sociedade Brasileira de Reumatologia para Diagnóstico e Tratamento da Febre Chikungunya, que trata especificamente do tratamento.

Arthritis Care and Research, Apr 12, 2018

Objectives-To assess hepatitis B (HBV) reactivation rates in patients with resolved or chronic HB... more Objectives-To assess hepatitis B (HBV) reactivation rates in patients with resolved or chronic HBV infection, receiving Disease Modifying Anti-Rheumatic Drugs (DMARDs) and with or without antiviral prophylaxis. Methods-We conducted a systematic review and meta-analysis. Electronic searches were conducted in Pubmed, Medline and EMBASE using OVID through 12/31/2015. A search strategy was developed for each database using the following inclusion criteria: participants (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, resolved, or chronic HBV infection), interventions (TNF inhibitors, non-TNF biologic or non-biologic DMARDs), and outcomes (hepatitis B reactivation). Four reviewers independently extracted study data and assessed study quality with the Newcastle-Ottawa scales. To determine the pooled hepatitis B reactivation rate, the variances of the raw proportions were stabilized using a Freeman-Tukey-type arcsine square root transformation, using a random-effects model. Results-Twenty-five studies met the inclusion criteria. The overall pooled rate of hepatitis B reactivation was 1.6% (95% CI, 0.8-2.6%) in patients with resolved hepatitis B. Similar rates were observed in resolved patients on TNF inhibitors (1.

quarter. Related to the diagnosis, it was observed that 34% of the patients reported a feeling of... more quarter. Related to the diagnosis, it was observed that 34% of the patients reported a feeling of anxiety, surprise, fright and fear; 27% reported feelings of abandon and helplessness when faced with becoming ill; 24% expected the diagnosis due to previous pregnancies, albeit with negative feelings, and; 15% were not able to express in words the feelings that had been triggered. As for the fetal repercussions of the diagnosis, 55% expressed fear of fetal malformation, 35% feared prematurity and 10% did not relate any fetal repercussion to it. Related to the hospitalization, it was observed that 64% reported negative sentiments (anguish, increased anxiety, fear and sadness, restricted eating) and 36% described hospitalization with positive feelings (support, protection and care). Conclusion The high-risk pregnancy may trigger a disorganization of thoughts and feelings, intensifying anxieties, fears and negative beliefs. As for hospitalization, more than half of the cohort presents negative feelings, such as something threatening to the continuity of the gestation. The increase in anxiety also stems from the necessity of getting accustomed to the controlled hospital diet. However, a considerable percentage understands hospitalization as protective, nurturing feelings of emotional continence and support.

Annals of the Rheumatic Diseases, Jun 1, 2013

Background: Shared decision making (SDM) has been advocated as the preferred form of decision mak... more Background: Shared decision making (SDM) has been advocated as the preferred form of decision making over the past two decades. Literature has shown discrepancies among all health stakeholders' understanding about shared-decision making concept. Objectives: Evaluate primary care patients' understanding of SDM concept in a Brazilian town and describe their willingness to be involved in their own healthcare plan. Also, examine patients' opinion regarding the role of multiprofessional team in the quality of care. Methods: This is a quantitative study. All patients registered in a primary care unit were asked to participate. A questionnaire covering demographic and clinical data, and patients opinions regarding the role of the multiprofessional team on the quality of care was applied. Three scenarios that presented different models of clinical encounter (paternalistic, informed and shared decision making) were presented. Outcome measures were the answers from the questionnaire and the answers regarding the scenarios. Statistical analysis was performed through measures of central tendency and dispersion. The associations among the categories were conducted by correspondence analyses (multivariate analysis). This study was approved by Research Ethics Committee. Results: We interviewed 278 patients, 50% Caucasian, 79% female, 24% between 20 and 29 years old and 42% with incomplete primary education. 78% of the respondents consider that multidisciplinary work team is important to improve patient's knowledge regarding the disease they had. When asked about patient's involvement in the health plan decisions, 78.4% prefer to decide about the treatment with the doctor. Despite of this result, when asked about the meaning of SDM, paternalistic and informed decision-making, 83% defined SDM and informed decision making as similar concepts. A correspondence analysis plot illustrated that females, mestizos, and aged between 30 and 39 year olds were associated with more willingness to share the decisions with the physician. There was no association between comprehension about decisionmaking and having a chronic disease. Conclusions: The level of understanding of the difference between informed, shared and paternalistic decision-making is not clear from this sample. This study demonstrated that patients in primary care consider that a multiprofessional teamwork is significant to improve patient's knowledge regarding their disease. References: 1. Abreu, MM; Gafni, A; Ferraz, MB. Development and testing of a decision board to help clinicians present treatment options to lupus nephritis patients in Brazil.

Journal of Bone and Mineral Research

ABSTRACTIn this international study, we examined the incidence of hip fractures, postfracture tre... more ABSTRACTIn this international study, we examined the incidence of hip fractures, postfracture treatment, and all‐cause mortality following hip fractures, based on demographics, geography, and calendar year. We used patient‐level healthcare data from 19 countries and regions to identify patients aged 50 years and older hospitalized with a hip fracture from 2005 to 2018. The age‐ and sex‐standardized incidence rates of hip fractures, post‐hip fracture treatment (defined as the proportion of patients receiving anti‐osteoporosis medication with various mechanisms of action [bisphosphonates, denosumab, raloxifene, strontium ranelate, or teriparatide] following a hip fracture), and the all‐cause mortality rates after hip fractures were estimated using a standardized protocol and common data model. The number of hip fractures in 2050 was projected based on trends in the incidence and estimated future population demographics. In total, 4,115,046 hip fractures were identified from 20 databas...

Advances in Rheumatology, 2021

Background There is a lack of information on the role of chronic use of hydroxychloroquine during... more Background There is a lack of information on the role of chronic use of hydroxychloroquine during the SARS-CoV-2 outbreak. Our aim was to compare the occurrence of COVID-19 between rheumatic disease patients on hydroxychloroquine with individuals from the same household not taking the drug during the first 8 weeks of community viral transmission in Brazil. Methods This baseline cross-sectional analysis is part of a 24-week observational multi-center study involving 22 Brazilian academic outpatient centers. All information regarding COVID-19 symptoms, epidemiological, clinical, and demographic data were recorded on a specific web-based platform using telephone calls from physicians and medical students. COVID-19 was defined according to the Brazilian Ministry of Health (BMH) criteria. Mann–Whitney, Chi-square and Exact Fisher tests were used for statistical analysis and two binary Final Logistic Regression Model by Wald test were developed using a backward-stepwise method for the pre...

Anais do Congresso Brasileiro de Reumatologia 2020, 2021

BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has caused restrictive measures, incl... more BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has caused restrictive measures, including suspension of face-to-face lectures, clerkship and internship in medical schools. Additionally, medical students were invited to participate on the front-lines against the COVID-19, which may have had negative impacts on students' mental health. The Mario Pinotti II study (MPII) is a multicenter study carried out to evaluate if hydroxychloroquine could have some protective role regarding moderate-severe forms of SARS-CoV-2 infection in patients with rheumatic diseases. Medical students were trained as voluntary evaluators to collect patient data during 24 weeks of follow-up. The aim of this study is to evaluate the effect of participation in MPII on medical students' mental health. MATERIALS AND METHODS This is a cross-sectional web survey designed to evaluate medical students participating in MPII, assigned as the volunteer group (VG), and their colleagues who were not involved in this project (control group [CG]), matched by sex and medical school (public and private background). The questionnaire was developed by the researchers and addressed demographic data, lifestyle habits, and participants' opinions about the MPII and the impact of the COVID-19 pandemic on their medical training routine. The domains of depression, anxiety and stress were assessed using the Brazilian version of the Depression, Anxiety and Stress Scale (DASS-21), which scores estimate the risk for mental suffering. Data collection was carried out from 20th July to 31st August 2020. The SPSS version 20.0 statistical package was used in all analyzes and a p-value of less than 0.05 was considered statistically significant. RESULTS A total of 684 medical students were included in our sample, 228 as VG and 456 as CG. Median age was 23 years (IQ 21-24) and the CG were older than the VG (p < 0.03). The majority of them were white (69%, self-reported), women (63%) and single marital status (97%). There was no significant difference regarding comorbidities, ethnicity, smoking status, alcohol use, physical activity and self-reported previous anxiety and depression. The DASS-21 scores presented significantly lower values in VG 12(0-56) than CG 15(0-61) (p = 0.001). CONCLUSION The participation of medical students in MPII study allowed social interaction with patients, colleagues, professors and medical assistants during COVID-19 pandemic, favoring higher inter-person engagement and better mental health status.

Blucher Medical Proceedings, 2019

BACKGROUND Vessel imaging in Takayasu arteritis (TA) is often performed in clinical practice foll... more BACKGROUND Vessel imaging in Takayasu arteritis (TA) is often performed in clinical practice following clinical symptoms such as limb claudication. Conversely, the correlation between limb claudication and vessel imaging manifestations has not been assessed.

Anais do Congresso Brasileiro de Reumatologia 2020, 2021

BACKGROUND Although several randomized clinical trials have demonstrated no evidence of using hyd... more BACKGROUND Although several randomized clinical trials have demonstrated no evidence of using hydroxychloroquine (HCQ) to manage patients with coronavirus disease 2019 (COVID-19), including mild, moderate and severe forms, as well as pre-and postexposition, there are still controversies regarding to patients who use it chronically, such as those with rheumatic diseases (RD). The aim of this work was to compare the incidence of hospitalization and the mortality rate related to suggestive COVID-19 between RD patients on HCQ and their household during 16-week follow-up. MATERIALS AND METHODS Adult RD patients on HCQ for at least 30 days prior to baseline were compared with adult's household cohabitants (no RD and not using antimalarials). Information regarding epidemiological, clinical data, COVID-19 symptoms, and hospitalizations were collected through every other week phone calls performed by physicians and medical students. The data were recorded on a specific web-based platform. All participants who completed the last study visit (from baseline to V6; during 16 weeks) were included in this analysis. A significant p-value was set as < 0.05. RESULTS Considering a total of 9,589 participants included at baseline, 5,574 (58.1%) of them completed the V6, of whom 3,473 RD patients. The clinical and epidemiological characterization at baseline were presented in other submission. Symptoms Realização Promoção

Advances in rheumatology, Mar 15, 2023

Clinical practice guidelines (CPG) are developed to align standards of health care around the wor... more Clinical practice guidelines (CPG) are developed to align standards of health care around the world, aiming to reduce the incidence of misconducts and enabling more effective use of health resources. Considering the complexity, cost, and time involved in formulating CPG, strategies should be used to facilitate and guide authors through each step of this process. The main objective of this document is to present a methodological guide prepared by the Epidemiology Committee of the Brazilian Society of Rheumatology for the elaboration of CPG in rheumatology. Through an extensive review of the literature, this study compiles the main practical recommendations regarding the following steps of CPG drafting: distribution of working groups, development of the research question, search, identification and selection of relevant studies, evidence synthesis and quality assessment of the body of evidence, the Delphi methodology for consensus achievement, presentation and dissemination of the recommendations, CPG quality assessment and updating. This methodological guide serves as an important tool for rheumatologists to develop reliable and high-quality CPG, standardizing clinical practices worldwide.

Annals of the Rheumatic Diseases, May 19, 2021

Conclusion: The innovative US teaching concept was able to demonstrate, that it is appropriate fo... more Conclusion: The innovative US teaching concept was able to demonstrate, that it is appropriate for the training of dermatologists in MSUS, independently of their age, experience in dermatology and US.

Annals of the Rheumatic Diseases, May 19, 2021

Objectives: In patients with rheumatic and musculoskeletal diseases (RMDs) and infected with Covi... more Objectives: In patients with rheumatic and musculoskeletal diseases (RMDs) and infected with Covid-19, we aim to investigate the role of systemic autoimmune conditions compared to other type of RMDs in severity of COVID-19 in terms of hospital admissions. Methods: An observational longitudinal study was conducted during the epidemic peak in Madrid (1 st Mar to 20 th May2020). All patients attended at the rheumatology outpatient clinic of a tertiary hospital with a diagnosis of RMDs and Covid-19 infection were included (according to a medical diagnosis or confirmed with a positive SARS-CoV-2 PCR diagnostic test). All patients were included since the time of COVID-19 diagnosis. Main variable: hospital admission related to Covid-19 infection. Independent variable: type of RMD including: autoimmune (systemic autoimmune conditions and inflammatory joint disease (IJD)) and nonautoimmune (mechanical diseases, and inflammatory diseases (microcrystalline arthritis and tendonitis)). Covariates: sociodemographic, clinical and therapy used. Statistical analysis: description of the sociodemographic, clinical and treatment characteristics of the patients. A multivariate logistic regression adjusted by age, sex and comorbidities was used to evaluate the risk of the different types of RMDs in hospital admissions related to Covid-19. The results were expressed as OR with its corresponding confidence interval (95% CI). Results: 406 patients were included with RMDs and Covid-19 infection. 69.21% were women with a mean age at diagnosis of 60 ± 15.26 years. The evolution time from the diagnosis of RMD was 8 ± 8.38 years. 26% had comorbidity at baseline. 25% were chronically on corticoids prior to the infection. Of the 406 patients, 244 (60.09%) had non-autoimmune RMD (157 mechanic, 87 inflammatory) and 162 (39.9%) (106 (65.43%) IJD, 56 (34.56%) systemic autoimmune condition) had autoimmune RMD. 36% of all patients were admitted (31% from not autoimmune RMDs and 43% from autoimmune RMD (p = 0,013). The risk of hospital admission in autoimmune RMD compared to non-autoimmune RMD was higher (OR: 1.68; [1.11-2.54], p=0.013), being the risk of systemic autoimmune condition compared to both IJD and non-autoimmune RMD higher (OR

Annals of the Rheumatic Diseases, May 19, 2021

Background: SLE disease activity tools do not optimally define disease activity and response. The... more Background: SLE disease activity tools do not optimally define disease activity and response. The SLEDAI arthritis item is common, and sufficient to define SRI response. Lupus patients with arthralgia often have no swelling. Glossary definitions of arthritis in different versions of the SLEDAI have included: swelling, swelling between visits, effusion, tenderness, warmth and erythema. MSK ultrasound in SLE can identify synovitis without swelling, ultrasound synovitis is associated with worse symptoms and serology, predicts response to therapy, and is more responsive to therapy than clinical variables. Objectives: To validate different glossary definitions for SLEDAI arthritis using musculoskeletal ultrasound. Methods: We analysed baseline data from a multicentre longitudinal study. Physicians scored SLEDAI-2K in 133 patients with joint pain that was considered inflammatory, but not necessarily swelling. Stable immunosuppressants and prednisolone <=5mg were permitted. If the arthritis criterion was scored, we asked physicians to report which glossary features drove their decision. Musculoskeletal ultrasound of hands and wrists was performed on the same day, blinded to clinical findings. We defined abnormal grey-scale in joints as 1 joint with GS>=2, and in tendons as >=1 tendon with GS >=1, and abnormal power Doppler as >=1 joint or tendon with PD >=1. Results: 78/133 patients had arthritis scored on SLEDAI-2K. In 21/78, swelling was not a reason for that decision. These 21 patients had either tenderness (16/21), swelling reported between visits (4/21) or both of these (1/21). No patient was scored for warmth, erythema or effusion alone. Comparison of SLEDAI definitions and ultrasound is shown in Table 1. Of 57 patients with SLEDAI arthritis scored due to swelling, 90% had an abnormal ultrasound. The positive predictive value was 89% (95% CI 79-94). Of 21 patients with SLEDAI arthritis scored without swelling, 48% had an abnormal ultrasound. The positive predictive value was 48% (95% CI 31-67). There was no substantive difference in clinical and serological variables comparing patients with SLEDAI arthritis without swelling and patients without SLEDAI arthritis. In contrast, patients with SLEDAI arthritis with swelling had worse ESR (p=0.0003), Physician MSK disease activity VAS (p<0.001) and patient EMS VAS (p=0.0019) and IgG (p=0.0625) compared to the other two groups. Conclusion: Although ultrasound proven synovitis in the absence of swelling is not uncommon, it is not reliably identified using other signs or symptoms. The arthritis item of the SLEDAI was likely to be associated with ultrasound synovitis if scored because of swelling, but not if scored because of tenderness or swelling between visits. Our results support raising the threshold criteria for arthritis so that it should only be scored when there is joint swelling. Previous clinical trial datasets could be re-analysed excluding SLEDAI arthritis scores not confirmed by a swollen joint count greater than one.

Revista Brasileira De Reumatologia, 2017

Revista Brasileira De Reumatologia, 2017

Clinical and experimental rheumatology, 2021

OBJECTIVES To evaluate the incidence of COVID-19 and its main outcomes in rheumatic disease (RD) ... more OBJECTIVES To evaluate the incidence of COVID-19 and its main outcomes in rheumatic disease (RD) patients on hydroxychloroquine (HCQ) compared to household cohabitants (HC). METHODS This is a 24-week nationwide prospective multi-centre cohort with a control group without RD and not using HCQ. All participants were monitored through scheduled phone interviews performed by health professionals. Details regarding COVID-19 symptoms, and epidemiological, clinical, and demographic data were recorded on a specific web-based platform. COVID-19 was defined according to the Brazilian Ministry of Health criteria and classified as mild, moderate or severe. RESULTS A total of 9,585 participants, 5,164 (53.9%) RD patients on HCQ and 4,421 (46.1%) HC were enrolled from March 29th, 2020 to September 30th, 2020, according to the eligibility criteria. COVID-19 confirmed cases were higher in RD patients than in cohabitants [728 (14.1%) vs. 427 (9.7%), p<0.001] in a 24-week follow-up. However, there...

Arquivos Brasileiros de Oftalmologia

Lupus retinopathy is a clinical manifestation of systemic lupus erythematosus in the visual syste... more Lupus retinopathy is a clinical manifestation of systemic lupus erythematosus in the visual system. It is generally asymptomatic; however, it can become a threatening condition. It is closely associated with the inflammatory activity and higher mortality of systemic lupus erythematosus. Lupus retinopathy has several different clinical presentations, such as lupus microangiopathy, vascular occlusion, vasculitis, hypertensive retinopathy associated with lupus nephritis, and autoimmune retinopathy. Although the prevalence and associated factors of lupus retinopathy have been well defined in some parts of the world, there are no data from Latin America, including Brazil. As lupus retinopathy is generally asymptomatic, without a routine fundoscopy, it has been probably underestimated. This review is intended to discuss the epidemiology and risk factors of lupus retinopathy.

BV UNIFESP: Teses e dissertaçõe