Made available in DSpace on 2016-12-06T17:07:29Z (GMT). No. of bitstreams: 1 Amabile.pdf: 1657607 bytes, checksum: 80e4e884bc9071dca3c66d17e5270ab0 (MD5) Previous issue date: 2011-03-06 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Objectives: the aim of this study was to evaluate the effects of aquatic exercise program on disease activity, functional hability and quality of life in patients with activity rheumatoid arthritis (RA). Methods: Twenty-six patients were divided in order of referral to an exercise group (EG-n=7) and a control group (CG-n=9). The EG participated of aquatic exercise program 3 times a week for 13 weeks, with sessions of 50 minutes. The CG continued with their previous activity without interference of the researchers. The disease activity was measured by Disease Activity Score 28(DAS28). Two tests was chosen for measure functional hability: Timed Up and Go(TUG) test and Functinal Reach test (FRT). The quality of life were measured by Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Results: Significant differences between the groups EG and CG were found for the number of tender joints. Significant improvements within-group was found in the disease activity (number of swollen joints and tender joints decreased, PCR decreased and global disease activity measure improved), functional hability (FRT) and quality of life (pain perception decreased) for the EG; in the CG significant improvements was found only the PCR. Conclusion: There is initial evidence that patients with active RA can do water exercises. Because it was effective in reducing disease activity and improving functional capacity, although no major changes in quality of life. However, the population studied was small and further studies are requested in a larger population and for longer time. / Objetivo: Investigar o efeito de um programa de exercícios aquáticos de 13 semanas sobre a atividade da doença, capacidade funcional e qualidade de vida, em pacientes com artrite reumatóide (AR) ativa. Método: 16 pacientes foram divididos, por ordem de encaminhamento, em grupo exercício (GE - n=7) e grupo controle (GC - n=9). O GE participou de um programa de exercício aquático, realizado 3 vezes por semana, com sessões de 50 minutos de duração. O GC continuou suas atividades habituais sem interferência dos pesquisadores. A atividade da doença foi medida pelo Disease Activity Score 28 (DAS28). Dois testes foram escolhidos para avaliar a capacidade funcional: Teste Timed Up and GO (TUG) e Teste de Alcance Funcional (TAF). A qualidade de vida foi avaliada através do Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Resultados: Foi encontrada diferença significativa entre os grupos GE e GC no número de articulações doloridas (DAS28). Nas medidas intragrupo, foram encontradas melhoras significativas nos indivíduos do GE na atividade da doença (redução do número de articulações edemaciadas e doloridas, redução da PCR e melhora da percepção da atividade global da AR), na capacidade funcional (TAF) e na qualidade de vida (diminuição da percepção de dor). No GC houve melhora significativa somente nos valores de PCR. Conclusão: Há evidências inicias de que exercício aquático pode ser realizado por pacientes com AR ativa, pois foi efetivo na diminuição da atividade da doença e na melhora da capacidade funcional, embora sem grandes alterações na qualidade de vida dos sujeitos. Porém, ressalta-se que a amostra do estudo foi pequena e são necessários estudos futuros com maior número de pacientes e maior tempo de intervenção.

Introduction: The inflammation plays the essential role in the bone loss in juvenile idiopathic arthritis (JIA). Proinflammatory cytokines and also glucocorticoids (GCs) may activate bone resorption by osteoclasts. Simultaneously, bone formation can be attenuated, especially by inhibitors of proteins, which control the osteoblast differentiation. The aim was to verify the hypothesis that in patients with highly active JIA, reduction of bone formation via Wingless (Wnt) proteins inhibitors - Dickkopf 1 (Dkk-1) and sclerostin could be found. Except the densitometry measurements of bone and lean mass, we assessed markers of disease activity, bone metabolism and remodeling in young adult patients with JIA before and during 2 years of anti TNFα (tumour necrosis factor α) treatment, which decreases disease activity. Results: In patients with JIA before antiTNFα treatment, bone mineral density (BMD, g/cmš) was significantly reduced compared to controls. Values of BMD and body composition in JIA significantly depended on disease duration and GCs treatment. Serum concentration of sclerostin was significantly elevated in JIA compared to values in healthy controls. Values of the other monitored markers did not differ between JIA and controls. In patients with JIA, Dkk-1 correlated positively with C-reactive...

Submitted by isabela.moljf@hotmail.com (isabela.moljf@hotmail.com) on 2017-05-19T15:53:35Z No. of bitstreams: 1 vivianeangelinadesouza.pdf: 3640285 bytes, checksum: 152523820a34f8ec9830975c379401af (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-05-19T15:56:45Z (GMT) No. of bitstreams: 1 vivianeangelinadesouza.pdf: 3640285 bytes, checksum: 152523820a34f8ec9830975c379401af (MD5) / Made available in DSpace on 2017-05-19T15:56:45Z (GMT). No. of bitstreams: 1 vivianeangelinadesouza.pdf: 3640285 bytes, checksum: 152523820a34f8ec9830975c379401af (MD5) Previous issue date: 2012-03-08 / Atualmente, é descrito papel imunomodulador da vitamina D, além de seu já reconhecido efeito na manutenção da homeostase óssea. A insuficiência de vitamina D é considerada epidêmica, e pode influenciar a patogenia de doenças autoimunes, como o Lúpus Eritematoso Sistêmico (LES). Este estudo avaliou a prevalência de insuficiência de vitamina D em pacientes com LES comparados a controles saudáveis, além de associações entre vitamina D e manifestações clínicas, nefrite lúpica, atividade da doença e densidade mineral óssea (DMO). A vitamina D foi avaliada pela análise sérica da 25-hidroxivitamina D [25(OH)D] por cromatografia líquida de alta performance (HPLC) e níveis inferiores a 30 ng/mL foram considerados insuficientes. Foram avaliados 45 pacientes com LES e 25 controles saudáveis. A mediana (mínimo-máximo) da 25(OH)D foi 29,48 (20,83-44,23) ng/mL no grupo doente e 37,68 (22,91-44,07) ng/mL nos controles (p<0,0001). Ocorreu prevalência de insuficiência de 25(OH)D em 55% dos pacientes e 8% dos controles (p=0,001). A vitamina D associou-se com tempo de duração da doença (r=0,311; p=0,037) e uso de hidroxicloroquina (r=-0,337; p=0,024). Houve fraca evidência de associação inversa entre vitamina D e interleucina (IL)-6 (r=-0,276; p=0,066). Não houve associação entre 25(OH)D e nefrite lúpica ou densidade mineral óssea. O modelo de regressão logística multivariada evidenciou maior chance de ocorrer 25(OH)D < 30 ng/mL no grupo de pacientes lúpicos que nos controles (OR: 78,25;p=0,0001), quando ajustado para possíveis variáveis confundidoras. Nos pacientes lúpicos, a hipovitaminose D mostrou-se prevalente. A vitamina D associou-se com tempo de duração da doença e uso de hidroxicloroquina. / Currently, it is described an immunomodulator role of vitamin D besides its already known effect on bone homeostasis. Vitamin D insufficiency is considered to be epidemic and may influence the pathogenesis of autoimmune diseases, like Systemic Lupus Erythematosus (SLE). This study evaluated the prevalence of vitamin D insufficiency in patients with SLE compared to healthy controls, and the association between vitamin D and clinical parameters, lupus nephritis, disease activity and bone mineral density (BMD). Vitamin D was evaluated by serum analysis of 25-hydroxyvitamin D [25(OH)D] by high performance liquid chromatography (HPLC) and levels below 30 ng/mL were considered insufficient. We evaluated 45 patients with SLE and 25 healthy controls. Median (range) of 25(OH)D was 29,48 (20,83-44,23) ng/mL in lupus patients and 37,68 (22,91-44,07) ng/mL in controls (p<0,0001). The prevalence of 25(OH)D insufficiency was 55% in patients and 8% in controls (p=0,001). Vitamin D was associated with time of disease duration (r=0,311; p=0,037) and use of hydroxychloroquine (HXQ) (r=-0,337; p=0,024). There was a weak evidence of inverse association between vitamin D and interleukin (IL)-6 in patients with SLE (r=-0,276; p=0,066). No association between 25(OH)D and lupus nephritis or bone mineral density was found. Multivariate logistic regression analysis evidenced higher probability of 25(OH)D < 30 ng/mL in SLE patients than in controls (OR: 78,25; p=0,0001), when adjusted to possibly confounding variables. In lupus patients, hypovitaminosis D was prevalent. Vitamin D was associated with time of disease duration and use of hydroxychloroquine.

Introduction: The inflammation plays the essential role in the bone loss in juvenile idiopathic arthritis (JIA). Proinflammatory cytokines and also glucocorticoids (GCs) may activate bone resorption by osteoclasts. Simultaneously, bone formation can be attenuated, especially by inhibitors of proteins, which control the osteoblast differentiation. The aim was to verify the hypothesis that in patients with highly active JIA, reduction of bone formation via Wingless (Wnt) proteins inhibitors - Dickkopf 1 (Dkk-1) and sclerostin could be found. Except the densitometry measurements of bone and lean mass, we assessed markers of disease activity, bone metabolism and remodeling in young adult patients with JIA before and during 2 years of anti TNFα (tumour necrosis factor α) treatment, which decreases disease activity. Results: In patients with JIA before antiTNFα treatment, bone mineral density (BMD, g/cmš) was significantly reduced compared to controls. Values of BMD and body composition in JIA significantly depended on disease duration and GCs treatment. Serum concentration of sclerostin was significantly elevated in JIA compared to values in healthy controls. Values of the other monitored markers did not differ between JIA and controls. In patients with JIA, Dkk-1 correlated positively with C-reactive...

Background: As patients with multiple sclerosis (MS) require lifelong treatment, optimization of therapy with respect to efficacy and safety is needed to limit long-term disease progression. Patients with MS also need a range of health-related services. Satisfaction with these as well as treatment is clinically relevant because satisfied patients are more likely to adhere to therapy. The aim of this study was to determine the status of patient satisfaction and of healthcare services in 70 specialized MS centres in Germany. Methods: In 2011, patients with MS responded to a questionnaire, which solicited clinical and demographic information, as well as patients’ perceptions of their overall situation and their satisfaction with treatment. Results: Of 2791 patients surveyed, 81.9% had relapsing-remitting MS with mild disability [mean (standard deviation) Expanded Disability Status Scale score: 2.6 (1.8)]. Disease activity data were collected from 2205 patients, of whom 57.6% had remained relapse-free during the preceding 12 months. However, 38.9% had experienced one or more relapses, most of whom (67.3%) while receiving immunomodulatory treatment. About one-third of the patients indicated that they were more dissatisfied with their overall situation compared with the time before diagnosis. However, many patients (58.3%) were satisfied with their existing medication. Overall, 72.8% of patients would prefer oral to injectable treatments, assuming there was no difference in their efficacy. Conclusions: A substantial proportion of patients experienced breakthrough disease on treatment and may potentially benefit from a change of therapy. Although largely satisfied with treatment, most patients with MS would choose oral over injectable treatments.

<p>Patients with rheumatoid arthritis (RA) are at increased risk of developing malignant lymphoma, although details about this association remain unclear. The aims of this thesis were to investigate risk factors for lymphoma in patients with RA and to characterize these lymphomas regarding subtype, presence of Epstein-Barr virus (EBV), clinical manifestations and prognosis. </p><p>The Swedish hospital discharge register and the cancer register were used to identify RA patients with lymphoma. Two case-control studies were performed, one smaller including RA patients with lymphoma hospitalised in Uppsala health care region 1964-1983 (n=41) and one larger study of hospitalised RA patients with lymphoma in Sweden 1964-1995 (n=378). RA patients from the same cohorts, but without lymphoma, were matched as controls. Medical records for cases and controls were scrutinized for exposure information. The lymphoma tissues were reclassified according to the WHO classification, and presence of EBV was analysed by EBER in situ hybridisation.</p><p>The most important risk factor for lymphoma development was high RA disease activity. No association was determined between treatment with traditional disease modifying drugs, non-steroidal anti-inflammatory drugs, aspirin, peroral and intra-articular corticosteroids and lymphoma risk. Diffuse large B-cell lymphoma (DLBCL) was more frequent in RA patients than in lymphoma patients in the general population and displayed stronger association with RA disease activity than other lymphoma subtypes. RA patients with DLBCL had increased extranodal involvement and more advanced lymphoma stage at presentation than DLBCL patients in general, and the prognosis was poor. </p><p>A further subdivision of DLBCL into germinal centre (GC) and non-GC subtypes by the expression patterns of CD10, bcl-6 and IRF-4 showed a predominance of the non-GC subtype. This suggested peripheral activated B-cells as the cells of origin in these lymphomas. </p><p>The presence of EBV was low in lymphomas in RA patients (12%). </p>

Patients with rheumatoid arthritis (RA) are at increased risk of developing malignant lymphoma, although details about this association remain unclear. The aims of this thesis were to investigate risk factors for lymphoma in patients with RA and to characterize these lymphomas regarding subtype, presence of Epstein-Barr virus (EBV), clinical manifestations and prognosis. The Swedish hospital discharge register and the cancer register were used to identify RA patients with lymphoma. Two case-control studies were performed, one smaller including RA patients with lymphoma hospitalised in Uppsala health care region 1964-1983 (n=41) and one larger study of hospitalised RA patients with lymphoma in Sweden 1964-1995 (n=378). RA patients from the same cohorts, but without lymphoma, were matched as controls. Medical records for cases and controls were scrutinized for exposure information. The lymphoma tissues were reclassified according to the WHO classification, and presence of EBV was analysed by EBER in situ hybridisation. The most important risk factor for lymphoma development was high RA disease activity. No association was determined between treatment with traditional disease modifying drugs, non-steroidal anti-inflammatory drugs, aspirin, peroral and intra-articular corticosteroids and lymphoma risk. Diffuse large B-cell lymphoma (DLBCL) was more frequent in RA patients than in lymphoma patients in the general population and displayed stronger association with RA disease activity than other lymphoma subtypes. RA patients with DLBCL had increased extranodal involvement and more advanced lymphoma stage at presentation than DLBCL patients in general, and the prognosis was poor. A further subdivision of DLBCL into germinal centre (GC) and non-GC subtypes by the expression patterns of CD10, bcl-6 and IRF-4 showed a predominance of the non-GC subtype. This suggested peripheral activated B-cells as the cells of origin in these lymphomas. The presence of EBV was low in lymphomas in RA patients (12%).

Made available in DSpace on 2016-12-06T17:06:55Z (GMT). No. of bitstreams: 1 Rodrigo da Rosa Iop.pdf: 1224669 bytes, checksum: 3bae5d9fc8b8bd98eb6a51475f81d1e3 (MD5) Previous issue date: 2013-06-04 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Este estudo teve como objetivo analisar os parâmetros da curva de força de preensão manual isométrica máxima em mulheres com artrite reumatoide e a sua relação com a atividade da doença. Participaram deste estudo 9 mulheres com artrite reumatoide e 10 mulheres saudáveis, pareadas por idade. A média de idade das mulheres com artrite foi de 56,66±11,81 e das saudáveis foi de 56,0±11,42. Foram utilizada ficha de avaliação, escala de Graffar para determinar o nível sociocenômico e o inventário de Edinburg, a fim de determinar a dominância lateral. Para avaliar o nível da atividade da doença foi utilizado Disease Activity Score por meio da Proteína C-Reativa. Para avaliação dos parâmetros da curva força vs tempo de preensão manual foi utilizado dinamômetro digital produzido pelo Laboratório de Instrumentação da Udesc por meio de janelas de tempo (0-30ms; 0-50ms; 0-100ms) Os parâmetros analisados foram: força de preensão máxima, tempo para atingir a força de preensão máxima, taxa de desenvolvimento da força e o pico da taxa de desenvolvimento da força para o lado dominante e não dominante. Para comparar a média dos parâmetros da curva de força de preensão manual isométrica máxima vs tempo entre os grupos foi utilizado o Teste T para amostras independentes. A relação entre os parâmetros da curva de força de preensão e o Disease Activity Score, bem como a Proteina C-Reativa nas mulheres com artrite foi verificada por meio da correlação de Pearson. A relação entre os parâmetros da curva de força de preensão manual isométrica máxima vs tempo e o número de articulações dolorosa, edemaciadas e a percepção geral de saúde foi verificada através do teste de Spearman. A força máxima e o pico da taxa de desenvolvimento apresentaram diferença significativa entre os grupos. Foi possível verificar associação linear entre o Disease Activity Score com tempo para atingir a força máxima do lado não dominante e com a taxa de desenvolvimento da força (0-100ms) do lado dominante, bem como entre a Proteína C-Reativa com a força máxima, tempo para atingir a força máxima dominante e a taxa de desenvolvimento da força (0-100ms) dominante e o pico da taxa de desenvolvimento da força de ambos os lados. As informações sobre os parâmetros da curva força vs tempo durante a contração isométrica máxima podem contribuir na avaliação da fraqueza muscular e incapacidade gerada pelo processo inflamatório em pacientes com artrite, tornando-se uma ferramenta útil para fins preventivos e de reabilitação.

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