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Introdução: O Lúpus eritematoso sistêmico (LES) é uma doença inflamatória autoimune crônica de etiologia ainda pouco conhecida, e de natureza pleomórfica, que intercala períodos de atividade e remissão. O desenvolvimento da autoimunidade no LES está associado à perda da tolerância imunológica e do controle imunorregulatório, tendo seus achados clínicos e laboratoriais variados. A atividade do LES pode ser medida pelo SLEDAI (systemic lupus erythematosus disease activity index) que é uma ferramenta complexa e que exige treinamento e conhecimento para sua aplicação. O volume plaquetário médio (VPM) é um marcador de ativação de plaquetas associado à inflamação, o que o torna um potencial candidato para a avaliação de atividade de doença no LES. Objetivos: Avaliar o VPM em pacientes com LES e comparar com indivíduos hígidos. Estudar a correlação entre o VPM e o índice de atividade de doença (SLEDAI) nos pacientes com LES. Analisar a correlação entre o VPM e a velocidade de sedimentação globular (VSG), a proteína C reativa (PCR), e os componentes do complemento C3 e C4 Métodos: Estudo transversal no qual foram incluídos 81 pacientes com LES segundo critérios de classificação diagnóstica do American College of Rheumatology (ACR), e 58 controles hígidos. Os pacientes foram selecionados consecutivamente por conveniência, de acordo com exames laboratoriais e SLEDAI devidamente calculados. As coletas foram realizadas entre outubro de 2015 e julho de 2016. LES ativo foi definido como SLEDAI>0 no momento da coleta. O VPM foi analisado no equipamento de automação Sysmex XE 5000. Resultados: O VPM estava reduzido nos pacientes com LES em atividade, quando comparado ao grupo de pacientes com LES inativo (10,0±0,7fL vs. 10,7±1,0fL, p=0,005). Existe uma fraca correlação inversa entre o valor do SLEDAI e o VPM (r=-0,29, p=0,009). Houve uma diferença significativa no VPM entre o grupo dos controles e os pacientes com LES ativo / Background Systemic Lupus Erythematosus (SLE) is an inflammatory autoimmune chronic disease etiology still unknown, and pleomorphic nature, which intersperses periods of activity and remission. The development of autoimmunity in SLE is related to loss of immunological tolerance and immunoregulatory control and clinical symptoms can be varied. The SLE activity can be measured by SLEDAI (systemic lupus erythematosus disease activity) which is a complex tool and it requires time and knowledge for your application. The MPV (mean platelet volume) is a marker of platelet activation and has been shown to be associated with inflammation, which makes it a potential candidate for use in the assessment of disease activity in SLE. In this study, we evaluated the MPV (Mean platelet volume) in healthy individuals and compared with SLE patients and correlate with SLEDAI VPM. Objectives: -To evaluate the MPV in SLE patients and compared with healthy individuals; to study the correlation between MPV and the SLEDAI patients with SLE and assess a possible correlation between MPV with erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), complement 3 (C3), and complement 4 (C4) Methods: This is a cross-sectional study in which 81 patients with SLE according to the American College of Rheumatology (ACR) diagnostic classification criteria and 58 healthy controls were included. Patients were selected for convenience, according to laboratory tests and SLEDAI duly calculated. The collections were carried out between October 2015 and July 2016. Active LES was defined as SLEDAI>0 at the time of collection. The VPM was analyzed in the Sysmex XE 5000 automation equipment. Results: In this study in patients with active SLE, the MPV is reduced when compared to the group of patients with inactive SLE [10.0±0.7fL vs. 10.7±1.0fL, p=0.005]. There is a weak inverse correlation between the SLEDAI value and the MPV (r=-0.29, p=0.009). There was a significant difference between the control group and the patients with active SLE (10.9 ±1.0fL vs. 10.0±0.7fL, p <0.001). In contrast, the MPV was similar between the control group and the group of patients with inactive SLE (10.9±1.0fLvs10.7±1.0fL, p=0.40). There was no correlation between MVP and CRP, ESR, C3 and C4. Conclusion: MPV is decreased in patients with active SLE and inversely correlated with SLEDAI. Despite the difference between MVP values, between active and inactive SLE patients, the results may not be clinically relevant. Prospective longitudinal studies are needed to better characterize the fluctuation of MPV in different states of disease activity to more clearly define the role of MPV in SLE.

Introdução: O Lúpus eritematoso sistêmico (LES) é uma doença inflamatória autoimune crônica de etiologia ainda pouco conhecida, e de natureza pleomórfica, que intercala períodos de atividade e remissão. O desenvolvimento da autoimunidade no LES está associado à perda da tolerância imunológica e do controle imunorregulatório, tendo seus achados clínicos e laboratoriais variados. A atividade do LES pode ser medida pelo SLEDAI (systemic lupus erythematosus disease activity index) que é uma ferramenta complexa e que exige treinamento e conhecimento para sua aplicação. O volume plaquetário médio (VPM) é um marcador de ativação de plaquetas associado à inflamação, o que o torna um potencial candidato para a avaliação de atividade de doença no LES. Objetivos: Avaliar o VPM em pacientes com LES e comparar com indivíduos hígidos. Estudar a correlação entre o VPM e o índice de atividade de doença (SLEDAI) nos pacientes com LES. Analisar a correlação entre o VPM e a velocidade de sedimentação globular (VSG), a proteína C reativa (PCR), e os componentes do complemento C3 e C4 Métodos: Estudo transversal no qual foram incluídos 81 pacientes com LES segundo critérios de classificação diagnóstica do American College of Rheumatology (ACR), e 58 controles hígidos. Os pacientes foram selecionados consecutivamente por conveniência, de acordo com exames laboratoriais e SLEDAI devidamente calculados. As coletas foram realizadas entre outubro de 2015 e julho de 2016. LES ativo foi definido como SLEDAI>0 no momento da coleta. O VPM foi analisado no equipamento de automação Sysmex XE 5000. Resultados: O VPM estava reduzido nos pacientes com LES em atividade, quando comparado ao grupo de pacientes com LES inativo (10,0±0,7fL vs. 10,7±1,0fL, p=0,005). Existe uma fraca correlação inversa entre o valor do SLEDAI e o VPM (r=-0,29, p=0,009). Houve uma diferença significativa no VPM entre o grupo dos controles e os pacientes com LES ativo / Background Systemic Lupus Erythematosus (SLE) is an inflammatory autoimmune chronic disease etiology still unknown, and pleomorphic nature, which intersperses periods of activity and remission. The development of autoimmunity in SLE is related to loss of immunological tolerance and immunoregulatory control and clinical symptoms can be varied. The SLE activity can be measured by SLEDAI (systemic lupus erythematosus disease activity) which is a complex tool and it requires time and knowledge for your application. The MPV (mean platelet volume) is a marker of platelet activation and has been shown to be associated with inflammation, which makes it a potential candidate for use in the assessment of disease activity in SLE. In this study, we evaluated the MPV (Mean platelet volume) in healthy individuals and compared with SLE patients and correlate with SLEDAI VPM. Objectives: -To evaluate the MPV in SLE patients and compared with healthy individuals; to study the correlation between MPV and the SLEDAI patients with SLE and assess a possible correlation between MPV with erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), complement 3 (C3), and complement 4 (C4) Methods: This is a cross-sectional study in which 81 patients with SLE according to the American College of Rheumatology (ACR) diagnostic classification criteria and 58 healthy controls were included. Patients were selected for convenience, according to laboratory tests and SLEDAI duly calculated. The collections were carried out between October 2015 and July 2016. Active LES was defined as SLEDAI>0 at the time of collection. The VPM was analyzed in the Sysmex XE 5000 automation equipment. Results: In this study in patients with active SLE, the MPV is reduced when compared to the group of patients with inactive SLE [10.0±0.7fL vs. 10.7±1.0fL, p=0.005]. There is a weak inverse correlation between the SLEDAI value and the MPV (r=-0.29, p=0.009). There was a significant difference between the control group and the patients with active SLE (10.9 ±1.0fL vs. 10.0±0.7fL, p <0.001). In contrast, the MPV was similar between the control group and the group of patients with inactive SLE (10.9±1.0fLvs10.7±1.0fL, p=0.40). There was no correlation between MVP and CRP, ESR, C3 and C4. Conclusion: MPV is decreased in patients with active SLE and inversely correlated with SLEDAI. Despite the difference between MVP values, between active and inactive SLE patients, the results may not be clinically relevant. Prospective longitudinal studies are needed to better characterize the fluctuation of MPV in different states of disease activity to more clearly define the role of MPV in SLE.

Introdução: O Lúpus eritematoso sistêmico (LES) é uma doença inflamatória autoimune crônica de etiologia ainda pouco conhecida, e de natureza pleomórfica, que intercala períodos de atividade e remissão. O desenvolvimento da autoimunidade no LES está associado à perda da tolerância imunológica e do controle imunorregulatório, tendo seus achados clínicos e laboratoriais variados. A atividade do LES pode ser medida pelo SLEDAI (systemic lupus erythematosus disease activity index) que é uma ferramenta complexa e que exige treinamento e conhecimento para sua aplicação. O volume plaquetário médio (VPM) é um marcador de ativação de plaquetas associado à inflamação, o que o torna um potencial candidato para a avaliação de atividade de doença no LES. Objetivos: Avaliar o VPM em pacientes com LES e comparar com indivíduos hígidos. Estudar a correlação entre o VPM e o índice de atividade de doença (SLEDAI) nos pacientes com LES. Analisar a correlação entre o VPM e a velocidade de sedimentação globular (VSG), a proteína C reativa (PCR), e os componentes do complemento C3 e C4 Métodos: Estudo transversal no qual foram incluídos 81 pacientes com LES segundo critérios de classificação diagnóstica do American College of Rheumatology (ACR), e 58 controles hígidos. Os pacientes foram selecionados consecutivamente por conveniência, de acordo com exames laboratoriais e SLEDAI devidamente calculados. As coletas foram realizadas entre outubro de 2015 e julho de 2016. LES ativo foi definido como SLEDAI>0 no momento da coleta. O VPM foi analisado no equipamento de automação Sysmex XE 5000. Resultados: O VPM estava reduzido nos pacientes com LES em atividade, quando comparado ao grupo de pacientes com LES inativo (10,0±0,7fL vs. 10,7±1,0fL, p=0,005). Existe uma fraca correlação inversa entre o valor do SLEDAI e o VPM (r=-0,29, p=0,009). Houve uma diferença significativa no VPM entre o grupo dos controles e os pacientes com LES ativo / Background Systemic Lupus Erythematosus (SLE) is an inflammatory autoimmune chronic disease etiology still unknown, and pleomorphic nature, which intersperses periods of activity and remission. The development of autoimmunity in SLE is related to loss of immunological tolerance and immunoregulatory control and clinical symptoms can be varied. The SLE activity can be measured by SLEDAI (systemic lupus erythematosus disease activity) which is a complex tool and it requires time and knowledge for your application. The MPV (mean platelet volume) is a marker of platelet activation and has been shown to be associated with inflammation, which makes it a potential candidate for use in the assessment of disease activity in SLE. In this study, we evaluated the MPV (Mean platelet volume) in healthy individuals and compared with SLE patients and correlate with SLEDAI VPM. Objectives: -To evaluate the MPV in SLE patients and compared with healthy individuals; to study the correlation between MPV and the SLEDAI patients with SLE and assess a possible correlation between MPV with erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), complement 3 (C3), and complement 4 (C4) Methods: This is a cross-sectional study in which 81 patients with SLE according to the American College of Rheumatology (ACR) diagnostic classification criteria and 58 healthy controls were included. Patients were selected for convenience, according to laboratory tests and SLEDAI duly calculated. The collections were carried out between October 2015 and July 2016. Active LES was defined as SLEDAI>0 at the time of collection. The VPM was analyzed in the Sysmex XE 5000 automation equipment. Results: In this study in patients with active SLE, the MPV is reduced when compared to the group of patients with inactive SLE [10.0±0.7fL vs. 10.7±1.0fL, p=0.005]. There is a weak inverse correlation between the SLEDAI value and the MPV (r=-0.29, p=0.009). There was a significant difference between the control group and the patients with active SLE (10.9 ±1.0fL vs. 10.0±0.7fL, p <0.001). In contrast, the MPV was similar between the control group and the group of patients with inactive SLE (10.9±1.0fLvs10.7±1.0fL, p=0.40). There was no correlation between MVP and CRP, ESR, C3 and C4. Conclusion: MPV is decreased in patients with active SLE and inversely correlated with SLEDAI. Despite the difference between MVP values, between active and inactive SLE patients, the results may not be clinically relevant. Prospective longitudinal studies are needed to better characterize the fluctuation of MPV in different states of disease activity to more clearly define the role of MPV in SLE.

Objective. This study was designed to test the hypotheses that a 16-week, individualized, intensive strength training program in rheumatoid arthritis (RA) patients taking Remicade™ (Infliximab) would improve strength, body composition, disease activity, physical function, pain and quality of life outcomes , as compared to RA patients on Remicade™ with no strength training program. Methods. Twenty-four patients with RA taking Remicade™, participated in a randomized, controlled trial. The exercise group carried out a three time a week strength training program, with the control group continuing standard of care. Assessments were completed at baseline, 8-week, and 16-week time points . Maximal strength, physical function, disease activity, body composition, quality of life, and pain were measured with active tests and via questionnaires. Patients also completed exit evaluations on their satisfaction with the study. Results. Highly significant strength gains were seen in the exercise group according to 3 repetition maximums (3RMs) (p<.01), as well as in all 8 exercises performed in the gym (p<.01). The mean exercise attendance for the 16 weeks was 82.0±10.6%. Compared to the control group, there was a significant increase in right hand grip strength (p<.1), and lean tissue in the trunk (p<.01). Significant improvements were also seen in physical function according to 50-foot walk time (p<.01), the Arthritis Impact Measurement Scale 2 (AIMS2) hand and arm function subscales (p<.05), and the Medical Outcomes Study Short Form 36 (MOS SF-36) (p<.1), as compared to controls. The exercise group showed clinically important differences via the Health Assessment Questionnaire Disability Index (HAQ DI), with a mean change of -0.41±0.42. Significant reductions in pain, as measured by the Pain Visual Analogue Scale (VAS), also occurred (p<.1). The individualization of the strength training program and personal attention received by the patients was critical to the success of the study. Patient satisfaction with the study was high, with limitations due primarily to funding constraints. Conclusion. This 16-week high intensity strength training program led to statistically significant improvements in strength, lean soft tissue, disease activity, function, pain and quality of life in this RA population. No detrimental effects on the disease were seen in this study.

Disease progression in rheumatoid arthritis (RA) is assessed by standard clinical, radiological and functional measures. Clinical disease activity in RA is graded as no disease (remission), low, moderate and high disease, based on validated criteria. Radiological progression in RA is monitored by serial x-rays of hands and feet, and by quantification of structural damage, using various scoring methods. This proves to be a valuable outcome measure in RA studies. RA patients with active disease usually develop progressive radiological damage. However, it has been shown that clinical disease activity may not correlate with radiological damage, particularly in early RA. Therefore, this thesis was mainly aimed to test the hypothesis that, „radiological damage can progress despite clinical disease inactivity or remission‟ and to investigate possible underlying mechanisms including disease heterogeneity, treatment effect and scoring methodology. Disease progression, outcomes and prognostic factors were analysed in an inception cohort of early RA (Early Rheumatoid Arthritis Study/ERAS) for this thesis. In this study of early RA patients, sustained remission was less frequent than remission at individual time points and baseline variables such as gender, duration of symptoms, disease activity (DAS) and health assessment questionnaire (HAQ) scores have shown predictive value for sustained remission. Structural damage on x-rays progressed despite clinical disease inactivity or remission in a subgroup of patients and disease heterogeneity was the most likely explanation for the disconnect between clinical disease activity and radiological damage in the ERAS cohort. This study has also found that scoring methods as well as reading order of x-ray films could influence radiographic progression in early RA, particularly at individual level. Male sex, rheumatoid factor (RF) and radiographic damage at baseline showed prognostic value in predicting radiographic progression despite remission. Study patients with persistent clinical disease inactivity have shown better radiological, surgical, functional, and other outcomes compared to relapsing-remitting or persistent disease activity. There was no significant difference in functional and other outcomes between patients in remission with x-ray progression and those in remission without xray progression. Therefore, x-rays of hands and feet at regular intervals are valuable in determining true disease progression in early RA, even during clinical disease inactivity. Scoring methodology in itself could have an influence on the type of radiographic progression in RA studies. Sustained disease inactivity in RA is more favourable than relapsingremitting disease.

Rheumatoid arthritis (RA) is a chronic autoimmune disease that is associated with formation of autoantibodies, activation of inflammatory cascade and up-regulation of several cytokines. These processes lead to persistent synovial inflammation, joint damage and systemic manifestations. The aim of this diploma thesis is to characterize the role of a novel cytokine interleukin-20 (IL-20) in the pathogenesis of RA and to investigate its involvement in different stages of the disease as a potential surrogate biomarker. In this work, several methods including Enzyme-Linked Immunosorbent Assay (ELISA), Immunohistochemistry and Real-Time quantitative Polymerase Chain Reaction (RT-qPCR) have been employed. We demonstrated increased expression of IL-20 in the synovial tissue of RA compared with control osteoarthritis (OA) patients. Along with the up-regulation at sites of inflammation, concentrations of IL-20 were higher in the synovial fluid compared with circulating levels of IL-20. Furthermore, serum and synovial fluid IL-20 levels significantly correlated with RA disease activity. Synthesis of IL-20 was significantly increased in peripheral blood mononuclear cells (PBMCs) and synovial fibroblasts upon stimulation with some TLR ligands and pro-inflammatory cytokines. Although not regulating PBMCs functions in...

Background: Rheumatoid arthritis (RA) is a common chronic autoimmune disorder characterised by persistent synovitis, typically manifested as symmetric polyarthritis of small hand joints with various extra-articular manifestations. Accurate disease activity measurement is a key component of RA management that facilitates therapeutic optimalization in order to slow down the disease progression and to prevent an irreversible joint damage. The aim of this work was to study the role of candidate serum inflammatory markers and their associations with the disease activity in patients with RA presented by traditional variables of disease activity as well as by musculoskeletal ultrasonography. Results: The first part of our work pointed out relationship between serum calprotectin and clinical as well as ultrasound activity in RA. We have revealed that serum calprotectin is an independent predictor of ultrasound synovitis. Moreover, we have demonstrated the potential of calprotectin to identify patients with residual activity in spite of achieving clinical remission. In the second part, we have provided a detailed analysis of 20 candidate serum markers and found out a tight associations between IL-6, IL-7, IL-22, IL-34, YKL-40, CXCL-13, MMP-3, resistin and visfatin with clinical and ultrasound activity....

Made available in DSpace on 2014-06-12T18:29:31Z (GMT). No. of bitstreams: 2 arquivo3460_1.pdf: 9606201 bytes, checksum: 522885c74fabba7080761a9a8396bd03 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2008 / Descoberto em 1975 o Parvovírus B19 (B19V) é o único membro da família Parvoviridae que apresenta comportamento patogênico em humanos. A persistência do vírus em vários tecidos, após infecção aguda, assim como sua presença em doenças do tecido conectivo e/ou autoimunes, reforça sua associação com várias patologias entre elas a Artrite Reumatóide (AR). Este trabalho teve como objetivos: verificar a associação entre infecção pelo B19V e o desenvolvimento da AR, traçar o perfil dos pacientes com AR quanto à atividade da doença utilizando o HAQ (The Health Assessment Questionnaire) e CDAI (Clinical Disease Activity Index) e correlacionar os dados encontrados com o resultado da sorologia para B19V. Trata-se de um estudo do tipo caso-controle com 92 portadores de AR e 92 com Osteoartrite (OA) constituindo o grupo controle, ambos originados do Ambulatório de Reumatologia do Hospital das Clínicas da Universidade Federal de Pernambuco. O estudo foi realizado de março a novembro de 2007. A sorologia para quantificação de IgG anti B19V foi realizada pelo ensaio imunoenzimático (ELISA) (RIDASCREEN®). Aplicou-se um questionário durante a entrevista para coleta de dados referente à doença. Foram excluídos da análise 18 pacientes por apresentarem resultado do ELISA indeterminado. Na análise observou-se predomínio do sexo feminino em mais de 90% no grupo de AR bem como em OA. A média de idade dos grupos foi de 50,5 ± 11,5 anos para AR e 57,4 ± 9,9 anos para OA respectivamente. Foi encontrada uma maior prevalência de IgG anti-B19V e um risco relativo de 2,69 (x2=26,40; p < 0,001) no grupo de AR quando comparados com o controle. Analisando os dados do HAQ, pudemos estimar que dos 74 pacientes, 30/74 (40,5%) apresentavam pouca ou nenhuma limitação funcional, 17/74 (23%) moderada limitação e 27/74 (36,5%) acentuada ou total incapacidade funcional. Segundo o CDAI observamos que dos 74 pacientes estudados, 14/74 (18,9%) sugeriam remissão do quadro de doença, 18/74 24,3%) baixa atividade de doença, 16/74 (21,6%) moderada atividade de doença e 26/74 (35,1%) doença em atividade. Não houve concordância entre os parâmetros de atividade da AR e a positividade para B19V. Os resultados encontrados sugerem a participação do B19V como um dos gatilhos que determinam o aparecimento da AR

Background: The aim of this cross-sectional study was to investigate potential associations between periodontal inflamed surface area (PISA) and tooth loss with disease-related parameters in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Methods: Patients who attended the Department of Nephrology and Rheumatology, University Medical Centre Goettingen, Germany, were included. The oral examination comprised the detection of the number of remaining teeth and periodontal condition based on staging and grading matrix. Based on periodontal pockets with positive bleeding on probing, the periodontal inflamed surface area (PISA) was determined. Disease related parameters were extracted from the patients’ records. Results: In total, 101 (RA) and 32 participants (AS) were included. Patients with RA had 22.85 ± 4.26 and AS patients 24.34 ± 5.47 remaining teeth (p < 0.01). Periodontitis stage III and IV was present in 91% (RA) and 81.2% (AS) of patients (p = 0.04). Associations between PISA and disease-related parameters were not found in both groups (p > 0.05). In RA, a higher age (p < 0.01), C-reactive protein (p = 0.02), disease activity (p < 0.01) and prednisolone intake (p < 0.01) were associated with fewer remaining teeth. In AS, a higher age (p = 0.02) and increased Bath Ankylosing Spondylitis Metrology Index (p = 0.02) were associated with a lower number of remaining teeth. Conclusions: Tooth loss is associated with disease activity, especially in RA individuals. Dental care to prevent tooth loss might be recommendable to positively influence oral health condition and disease activity in RA and SA patients.