abstract: ABSTRACT Despite significant advancements in drug therapy, cardiovascular disease (CVD) is still the leading cause of death in the United States. Given this, research has begun to seek out alternative approaches to reduce CVD risk. One of these alternative approaches is Vitamin D supplementation. Current research has shown a link between Vitamin D status and CVD risk in both healthy and diseased populations. Among the possible mechanisms is a positive effect of Vitamin D on vascular endothelial function, which can be measured with noninvasive techniques such as flow-mediated dilation (FMD) of conduit vessels using high-resolution ultrasound. This dissertation is comprised of two studies. The first examines whether Vitamin D supplementation can improve FMD in older adults within a time period (two weeks) associated with peak increases in plasma Vitamin D concentrations after a single-dose supplementation. The second examines the effect of Vitamin D supplementation in people with Rheumatoid Arthritis (RA). The reason for looking at an RA population is that CVD is the leading cause of early mortality in people with RA. In the first study 29 Post-Menopausal Women received either 100,000 IU of Vitamin D3 or a Placebo. Their FMD was measured at baseline and 2 weeks after supplementation. After 2 weeks there was a significant increase in FMD in the Vitamin D group (6.19 + 4.87 % to 10.69 + 5.18 %) as compared to the Placebo group (p=.03). In the second study, 11 older adults with RA were given 100,000 IU of Vitamin D or a Placebo. At baseline and one month later their FMD was examined as well as plasma concentrations of Vitamin D and tumor necrosis factor-alpha; (TNF-alpha;). They also filled out a Quality of Life Questionnaire and underwent a submaximal exercise test on the treadmill for estimation of maximum oxygen uptake (VO2max). There was no significant change in FMD in Vitamin D group as compared to the Placebo group (p=.721). Additionally, there was no significant improvement in either plasma Vitamin D or TNF-alpha; in the Vitamin D group. There was however a significant improvement in predicted VO2max from the submaximal exercise test in the group receiving Vitamin D (p=.003). The results of these studies suggest that a single 100,000 IU dose of Vitamin D can enhance FMD within two week in older adults, but that a similar dose may not be sufficient to increase FMD or plasma Vitamin D levels in older adults with RA. A more aggressive supplementation regimen may be required in this patient population. / Dissertation/Thesis / Ph.D. Exercise and Wellness 2012

Background: Presenteeism is an economic concept that is difficult to identify, measure, and value. Rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) are three chronic auto-immune conditions that increase levels of presenteeism. Workplace interventions (WPIs) help individuals to manage their health condition at work. Existing methods used to quantify the impact of presenteeism are unable to adequately inform the employer of the productive benefits of WPIs. The overall aim of this thesis was to appraise current methods used to quantify presenteeism and to develop methods to value the impact of presenteeism suitable for use in economic evaluations (EE) of WPIs. Methods: Two systematic reviews were conducted: 1) to assess the extent to which self-report measure of presenteeism were underpinned by economic theory; and 2) to explore if, and how, productivity was quantified and included in EE of WPIs for musculoskeletal conditions (MSDs). Thematic analysis methods were used to analyse qualitative data collected from working individuals with RA, AS or PsA (n=22) that explored the extent to which measures of health status (EQ5D; SF6D) and capability (ICECAP-A) capture the impact on ability to work caused by RA, AS or PsA. Econometric methods were used to specify prediction models that included measures of health status, capability and presenteeism, using a sample of 542 working people with RA and AS. Results The first systematic review identified 24 self-report measures of presenteeism; all, except one measure were not underpinned by economic theory. The second systematic review identified 20 EE of WPIs for MSDs. Absenteeism was included in all studies (n=20); however, presenteeism was included in only four. The qualitative data confirmed measures of health status and capability had the ability to capture those aspects of RA, AS and PsA that impact an individual’s ability to work. The best performing prediction model used an OLS specification including SF6D, age and gender to predict presenteeism measured by the WPAI. Conclusion: The results suggest that HRQoL measures, specifically the SF6D, can be used to capture and predict levels of presenteeism caused by RA, AS and PsA.

Introdução: Fadiga é uma manifestação clínica importante na artrite reumatoide (AR). Atualmente, a avaliação de fadiga em AR é realizada através de questionários subjetivos, incluindo aspectos emocionais e sociais. No entanto, sabe-se que a fadiga pode estar acentuada no plano periférico e esta abordagem é pouco estudada nestes pacientes. Objetivo: Avaliar a relação entre a percepção de fadiga e fadiga muscular em pacientes com artrite reumatoide. Métodos: Trinta e oito pacientes do sexo feminino com AR foram incluídos. Os pacientes foram estratificados por DAS-28 e por três grupos etários (grupo I: 32-48 anos; grupo II: 49-54 anos de idade, e grupo III: 55-65 anos de idade). A fadiga muscular [avaliado por mudanças na magnitude (root mean square-RMS) e freqüência (média de freqüência-MDF) de ativação muscular durante os 60s do teste de força de quadríceps] e percepção de fadiga (FACIT-F) foram avaliadas. Além disso, dados demográficos [duração idade e doença, calculado pelo tempo decorrido a partir de diagnóstico], hemoglobina (g/ dL), DAS-28, HAQ, qualidade de vida (SF-36) e International Physical Activity Questionnaire (IPAQ, versão longa) foram medidos. A significância foi assumida quando p≤0.05. Resultados: Nenhuma associação foi observada quando os pacientes foram estratificados por DAS-28 e quando os pacientes foram estratificados por idade no grupo III. Moderada correlações estatisticamente significativas entre MDF e FACIT-F e FACIT-TOI (r = 0,6; p = 0,03 e r = 0,5; 0,04, respectivamente) foram encontrados no grupo I. No grupo II foram encontradas moderadas correlações estatisticamente significativas entre FACIT-TOTAL e RMS e MDF (r = 0,6; p = 0,01 e r = -0,5; p = 0,04, respectivamente). Conclusão: Moderada relação entre fadiga muscular e percepção de fadiga sugere que ambas as estratégias de avaliação podem ser complementares e têm um efeito benéfico sobre comorbidades AR. / Introduction: Fatigue is a major clinical manifestation in rheumatoid arthritis (RA). Actually, the assessment of fatigue in RA is realized through to subjective questionnaires, including emotional and socials aspects. However, known to that fatigue may be sharp in peripheral plane and this approach is little studied in these patients. Objective: To assess the relationship between perception of fatigue and muscle fatigue in patients with RA. Methods: Thirty eight female patients with RA were included. Patients were stratified by DAS-28 and by three age groups (group I: 32-48 years old; group II: 49-54 years old; group III: 55-65 years old). Muscle fatigue [assessed by changes in magnitude (i.e. root mean square-RMS) and frequency (i.e. median frequency-MDF) of muscle activation during a 60-s quadriceps strength test] and perception of fatigue (FACIT-F) were assessed. In addition, demographic data [age and disease duration, calculated by elapsed time from diagnostic], hemoglobin (Hb-g/dL), DAS-28, HAQ, quality of life (SF-36) and International Physical Activity Questionnaire (IPAQ, long version) were measured. Significance was assumed when p≤0.05. Results: No association was observed when patients were stratified by DAS-28 and when patients were stratified by age in group III. Moderate statistically significant correlations between MDF and FACIT-F e FACIT-TOI (r=0.6;p=0.03 and r=0.5;0.04, respectively) were found in group I. In group II moderate statistically significant correlations were found between FACIT-TOTAL and RMS and MDF (r=0.6;p=0.01 and r=-0.5;p=0.04, respectively). Conclusion: Moderate relationship between muscle fatigue and perception of fatigue suggests that both evaluation strategies can be complementary and have a beneficial effect on RA comorbidities.

Made available in DSpace on 2014-06-11T19:35:13Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-07-05Bitstream added on 2014-06-13T19:05:33Z : No. of bitstreams: 1 capela_rc_dr_botfm.pdf: 824717 bytes, checksum: 146fb80f5dd8e57bfc17b7ae3936f9f3 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A atividade da artrite pode ser avaliada por diferentes instrumentos. Na Artrite Reumatóide (AR) o Disease Activity Score (DAS 28) e na Artrite Idiopática Juvenil (AIJ) o Juvenile Arthritis Disease Activity Score (JADAS) são utilizados na prática. Explorar a equivalência de medidas contínuas de atividade, o DAS 28 e as 3 versões do JADAS, pontuando 71, 27 e 10 articulações, em portadores de AIJ. Análise secundária de um ensaio clinico, testando o abatacepte em AIJ poliarticular, foi conduzida em 8 sujeitos durante 178 visitas, registrando-se a contagem articular, avaliação global pelo médico em escala analógica visual 0-10 (VAS-MD), avaliação global pelos pacientes/pais (VAS- P) e velocidade de hemossedimentação (VHS) normatizada para escala de 0-100. A comparação longitudinal foi por ANOVA ou modelo ajustado Gama. As observações pareadas entre o DAS 28 e JADAS 71, 27 e 10, respectivamente, foram analisadas por regressão linear após conversão logarítmica (ln). Medidas secundárias de desfecho da artrite como a capacidade funcional por meio do questionário “Childhood Health Assessment Questionnaire” (CHAQ), qualidade do sono por meio do Questionário de Hábitos do sono, limitação de atividades, peso, altura e adequação pondero-estatural foram avaliados de forma descritiva durante todas as visitas. As observações longitudinais das medidas primárias e secundárias de desfecho da artrite apresentaram diferença estatística entre a primeira e a segunda visita comparada as demais num total de 30 visitas e período de observação até 5 anos. As observações longitudinais indicaram diferença significante nos parâmetros DAS 28, JADAS 71, 27 e 10, VAS-MD, VAS-P entre as primeiras duas visitas do estudo original quando 5 atingiram a resposta ACR-Pedi 30 com melhora. A regressão linear para ajustamento do DAS 28 e JADAS resultou em fórmulas para conversão: DAS 28=1.263 x l.285 x In... / Arthritis activity may be assessed by different tools. For Rheumatoid Arthritis (RA), Disease Activity Score (DAS 28) and for Juvenile Idiopathic Arthritis (JIA) the Juvenile Arthritis Disease Activity Score (JADAS), are both used in practice. Explore equivalence of continuous measures of disease activity comparing DAS 28 and each of the 3 versions of JADAS based on 10-, 27- and 71- joint count, in patients with JIA. A secondary analysis of a randomized trial testing abatacept in polyarticular JIA was conducted. 178 assessments in 8 subjects were performed including standardized joint count, physician global assessment by Visual Analog Scale 0-10 (VAS-MD), global assessment by patients/parents (VAS-P) and erythrocyte sedimentation rate (ESR) normalized to 0-100 scale. Comparison by visit was done by ANOVA or gamma adjustment model. Paired observations of DAS 28 and JADAS 71-, 27- and 10-, respectively, were analysed by linear regression after logarithmic scale conversion (ln). Secondary outcome measures as functional capacity by CHAQ tool (Childhood Health Assessment Questionnaire), Sleep Habits Questionnaire, activity limitations, weight, length according to normative values were assessed by descriptive measures along all study visits. Longitudinal comparison of primary and secondary outcome measures resulted in significant difference among the first and second visits compared to the others making 30 visits until 5 years of long-term follow up. Longitudinal comparison by visit indicated significant difference in the first two visits of the original trial for the following parameters DAS 28, JADAS 71-, 27- and 10-, VAS-MD, VAS-P, when 5 subject reached ACR-Pedi 30 improvement response. Linear regression for adjustment between DAS 28 and each JADAS version resulted in transforming formulae: DAS 28=1.263 x ln (JADAS 71) - 1.267 (r2=0.81); DAS 28= 1.288 x ln (JADAS 27) – 1.297 (r2=0.80) e DAS 28= 1.285 x In ...

背景:類风湿性失节炎可归属于中医的“历节、“痹证的范畴，目前还缺乏明確的病因和发病机制，因此尚无有效的治疗方法，对该疾病的研究一直是个医學難題, 中医在RA的治疗方面积累了丰富的经验。中医因其经济实用、毒副作用少、普及性高的优势在这方面的临床治疗中具有一定优势。 目的: 总结相关证型对应用方的规律，以填补方证对应统一的空缺；自拟方作为臨床治疗类风湿性关节炎之基础方；选出各个随证加减之首选单味药。以期提高中醫药方药理论，其简明实用性便于临床掌握运用，确保治疗方便安全有效。 方法: 本文以“类风湿性失节炎、“中医为检索关键词’在维普期刊资源整合服务平台网帖，选取近15年中国医学期刊治疗类风湿关节炎的文章’对文章中出現的各个证型与之对应的主方进行统计；对文章里的复方中出现的高频单味药統計； 并对文章中各医家在临证随证加减用药的总结，兼证与对应的单味药使用頻次进行统计。 結果: 类风湿关节炎5个证型分别为湿热蕴结型、风寒湿痹型、肝肾亏虚型、痰提起痹阻型和阳虚寒湿型，它们分别对应的治疗主方为自虎加桂枝汤、揭痹汤、独活寄生汤、血府逐寐汤和乌头汤。根据单位高频药统计结果’自拟出方药由黄、當归、川芎、白芍、桂枝、细辛、独活、防风、牛膝、甘草、鸡血藤组成。临床中若见口渴、发热、局部红肿热痛等热症，选加石膏、知母、黄柏；见恶风、恶寒重、喜温等寒症，选力日川乌、熟附子、细辛；见湿邪重、因重戚强者，选加薏苡仁、苍术、土夜苓；见关节屈伸不利、强直畸形者，选加跟自公、乌梢蛇、全揭；病位在上肢者，选加姜黄、桑枝；病位在下肢者，选加牛膝、木瓜；腰背痛甚者’選加桑寄生、川断、杜仲；肩颈痛甚者’选加葛根、羌活、白芷。

Orientador: Claudia Saad Magalhães / Banca: Virginia Paes Leme Ferriani / Banca: Simone Appenzeller / Banca: José Eduardo Corrente / Banca: Ivete Dalben / Resumo: A atividade da artrite pode ser avaliada por diferentes instrumentos. Na Artrite Reumatóide (AR) o Disease Activity Score (DAS 28) e na Artrite Idiopática Juvenil (AIJ) o Juvenile Arthritis Disease Activity Score (JADAS) são utilizados na prática. Explorar a equivalência de medidas contínuas de atividade, o DAS 28 e as 3 versões do JADAS, pontuando 71, 27 e 10 articulações, em portadores de AIJ. Análise secundária de um ensaio clinico, testando o abatacepte em AIJ poliarticular, foi conduzida em 8 sujeitos durante 178 visitas, registrando-se a contagem articular, avaliação global pelo médico em escala analógica visual 0-10 (VAS-MD), avaliação global pelos pacientes/pais (VAS- P) e velocidade de hemossedimentação (VHS) normatizada para escala de 0-100. A comparação longitudinal foi por ANOVA ou modelo ajustado Gama. As observações pareadas entre o DAS 28 e JADAS 71, 27 e 10, respectivamente, foram analisadas por regressão linear após conversão logarítmica (ln). Medidas secundárias de desfecho da artrite como a capacidade funcional por meio do questionário "Childhood Health Assessment Questionnaire" (CHAQ), qualidade do sono por meio do Questionário de Hábitos do sono, limitação de atividades, peso, altura e adequação pondero-estatural foram avaliados de forma descritiva durante todas as visitas. As observações longitudinais das medidas primárias e secundárias de desfecho da artrite apresentaram diferença estatística entre a primeira e a segunda visita comparada as demais num total de 30 visitas e período de observação até 5 anos. As observações longitudinais indicaram diferença significante nos parâmetros DAS 28, JADAS 71, 27 e 10, VAS-MD, VAS-P entre as primeiras duas visitas do estudo original quando 5 atingiram a resposta ACR-Pedi 30 com melhora. A regressão linear para ajustamento do DAS 28 e JADAS resultou em fórmulas para conversão: DAS 28=1.263 x l.285 x In ... / Abstract: Arthritis activity may be assessed by different tools. For Rheumatoid Arthritis (RA), Disease Activity Score (DAS 28) and for Juvenile Idiopathic Arthritis (JIA) the Juvenile Arthritis Disease Activity Score (JADAS), are both used in practice. Explore equivalence of continuous measures of disease activity comparing DAS 28 and each of the 3 versions of JADAS based on 10-, 27- and 71- joint count, in patients with JIA. A secondary analysis of a randomized trial testing abatacept in polyarticular JIA was conducted. 178 assessments in 8 subjects were performed including standardized joint count, physician global assessment by Visual Analog Scale 0-10 (VAS-MD), global assessment by patients/parents (VAS-P) and erythrocyte sedimentation rate (ESR) normalized to 0-100 scale. Comparison by visit was done by ANOVA or gamma adjustment model. Paired observations of DAS 28 and JADAS 71-, 27- and 10-, respectively, were analysed by linear regression after logarithmic scale conversion (ln). Secondary outcome measures as functional capacity by CHAQ tool (Childhood Health Assessment Questionnaire), Sleep Habits Questionnaire, activity limitations, weight, length according to normative values were assessed by descriptive measures along all study visits. Longitudinal comparison of primary and secondary outcome measures resulted in significant difference among the first and second visits compared to the others making 30 visits until 5 years of long-term follow up. Longitudinal comparison by visit indicated significant difference in the first two visits of the original trial for the following parameters DAS 28, JADAS 71-, 27- and 10-, VAS-MD, VAS-P, when 5 subject reached ACR-Pedi 30 improvement response. Linear regression for adjustment between DAS 28 and each JADAS version resulted in transforming formulae: DAS 28=1.263 x ln (JADAS 71) - 1.267 (r2=0.81); DAS 28= 1.288 x ln (JADAS 27) - 1.297 (r2=0.80) e DAS 28= 1.285 x In ... / Doutor

Resumo: Tendo em vista que existem controvérsias na literatura quanto à existência de associação entre a doença periodontal e a artrite reumatóide e que as metodologias empregadas são tão diversas quanto os seus resultados e conclusões, este estudo transversal teve por objetivo avaliar a condição periodontal em portadores de artrite reumatóide e verificar se existe associação entre essas duas condições. Para isso, foram aplicados questionários de saúde geral e bucal, e foi realizado o exame periodontal em 49 portadores de artrite reumatóide e em 22 indivíduos não portadores de artrite reumatóide ou qualquer outra doença auto-imune. Fumantes e portadores de diabetes mellitus foram excluídos deste estudo. Os resultados indicaram que portadores de artrite reumatóide possuem menor número de dentes na cavidade bucal, apresentam maior extensão de placa bacteriana e maior proporção de sítios com perda de inserção periodontal avançada do que os indivíduos não portadores de artrite reumatóide Apesar da maior extensão de placa bacteriana dentre portadores de artrite reumatóide, a porcentagem de sítios que apresentaram sangramento marginal foi semelhante nos dois grupos, provavelmente devido ao uso de drogas antiinflamatórias e drogas de base, imunoreguladoras. Além disso, portadores de artrite reumatóide que utilizavam a associação de drogas de base apresentaram menor perda de inserção periodontal do que aqueles que não utilizavam a associação dessas drogas. Os resultados do estudo sugerem que existe associação entre periodontite e artrite reumatóide e que novos estudos serão necessários para identificar os fatores presentes nos portadores de artrite reumatóide que predispõem esses indivíduos a uma maior perda de inserção periodontal. / Abstract: There are controversies in the literature concerning the association between periodontal disease and rheumatoid arthritis. There are no consistent methodologies and results. The aim of this cross-sectional study was to assess periodontal condition in rheumatoid arthritis patients and verify if there is an association between these two conditions. We have produced general and dental health questionnaires and periodontal examination was achieved in 49 rheumatoid arthritis patients and 22 healthy individuals. Smokers and diabetes mellitus patients were excluded of the sample. Our results indicated that rheumatoid arthritis patients had lesser remaining teeth, higher extension of dental plaque and higher proportion of sites presenting advanced attachment loss than controls. Although rheumatoid arthritis patients had higher extension of dental plaque than the control group, gingival bleeding was similar between them, maybe because of the fact that rheumatoid arthritis patients take anti-inflammatory and disease-modifying antirheumatic drugs (DMARDs) for their treatment. Rheumatoid arthritis patients who were taking an association of two or more disease-modifying antirheumatic drugs had lesser attachment loss than patients that were taking only one of these drugs. Our results suggest that there is an association between periodontitis and rheumatoid arthritis and that more studies are required to identify specific risk factors for attachment loss in rheumatoid arthritis patients. / Orientador: Mirian Aparecida Onofre / Coorientador: Carlos Rossa Junior / Coorientador: Manoel Barros Bertolo / Banca: Silvana Regina Perez Orrico / Banca: Ricardo Guimarães Fischer / Mestre

Introdução: Fadiga é uma manifestação clínica importante na artrite reumatoide (AR). Atualmente, a avaliação de fadiga em AR é realizada através de questionários subjetivos, incluindo aspectos emocionais e sociais. No entanto, sabe-se que a fadiga pode estar acentuada no plano periférico e esta abordagem é pouco estudada nestes pacientes. Objetivo: Avaliar a relação entre a percepção de fadiga e fadiga muscular em pacientes com artrite reumatoide. Métodos: Trinta e oito pacientes do sexo feminino com AR foram incluídos. Os pacientes foram estratificados por DAS-28 e por três grupos etários (grupo I: 32-48 anos; grupo II: 49-54 anos de idade, e grupo III: 55-65 anos de idade). A fadiga muscular [avaliado por mudanças na magnitude (root mean square-RMS) e freqüência (média de freqüência-MDF) de ativação muscular durante os 60s do teste de força de quadríceps] e percepção de fadiga (FACIT-F) foram avaliadas. Além disso, dados demográficos [duração idade e doença, calculado pelo tempo decorrido a partir de diagnóstico], hemoglobina (g/ dL), DAS-28, HAQ, qualidade de vida (SF-36) e International Physical Activity Questionnaire (IPAQ, versão longa) foram medidos. A significância foi assumida quando p≤0.05. Resultados: Nenhuma associação foi observada quando os pacientes foram estratificados por DAS-28 e quando os pacientes foram estratificados por idade no grupo III. Moderada correlações estatisticamente significativas entre MDF e FACIT-F e FACIT-TOI (r = 0,6; p = 0,03 e r = 0,5; 0,04, respectivamente) foram encontrados no grupo I. No grupo II foram encontradas moderadas correlações estatisticamente significativas entre FACIT-TOTAL e RMS e MDF (r = 0,6; p = 0,01 e r = -0,5; p = 0,04, respectivamente). Conclusão: Moderada relação entre fadiga muscular e percepção de fadiga sugere que ambas as estratégias de avaliação podem ser complementares e têm um efeito benéfico sobre comorbidades AR. / Introduction: Fatigue is a major clinical manifestation in rheumatoid arthritis (RA). Actually, the assessment of fatigue in RA is realized through to subjective questionnaires, including emotional and socials aspects. However, known to that fatigue may be sharp in peripheral plane and this approach is little studied in these patients. Objective: To assess the relationship between perception of fatigue and muscle fatigue in patients with RA. Methods: Thirty eight female patients with RA were included. Patients were stratified by DAS-28 and by three age groups (group I: 32-48 years old; group II: 49-54 years old; group III: 55-65 years old). Muscle fatigue [assessed by changes in magnitude (i.e. root mean square-RMS) and frequency (i.e. median frequency-MDF) of muscle activation during a 60-s quadriceps strength test] and perception of fatigue (FACIT-F) were assessed. In addition, demographic data [age and disease duration, calculated by elapsed time from diagnostic], hemoglobin (Hb-g/dL), DAS-28, HAQ, quality of life (SF-36) and International Physical Activity Questionnaire (IPAQ, long version) were measured. Significance was assumed when p≤0.05. Results: No association was observed when patients were stratified by DAS-28 and when patients were stratified by age in group III. Moderate statistically significant correlations between MDF and FACIT-F e FACIT-TOI (r=0.6;p=0.03 and r=0.5;0.04, respectively) were found in group I. In group II moderate statistically significant correlations were found between FACIT-TOTAL and RMS and MDF (r=0.6;p=0.01 and r=-0.5;p=0.04, respectively). Conclusion: Moderate relationship between muscle fatigue and perception of fatigue suggests that both evaluation strategies can be complementary and have a beneficial effect on RA comorbidities.

Background: Rheumatoid arthritis (RA) is a chronic inflammatory joint disease. Physical activity is a cornerstone in the treatment. Hydrotherapy is an appreciated alternative for many patients. Quantitative research has been made in the area but to the authors’ knowledge, no qualitative studies have been made. Purpose: To explore and analyse the experiences of hydrotherapy among a group of people with RA with a focus on the impacts of the exercise form. Design and method: Explorative, descriptive qualitative design. Semi-structured interviews with five people with RA. A qualitative content analysis was chosen to process data. Results: Three themes were identified: The pros of exercising in water; The cons of exercising in water; When hydrotherapy is especially important. These themes contain eight categories: Effects; Important in implementation; Positive attributes of the pool; Community; Negative attributes of the pool; Availability; Bad periods; Disease severity; Konklusion: The informants especially highlighted the exercise effects, social aspects and the properties of water as pros. The hard pool floor and the inavailability were the primary cons experienced. Hydrotherapy seemed particularly incentivized when coupled with high disease severity. This study can serve as a foundation when choosing a physical activity intervention for this group. Future studies with similar purposes should include a larger sample.

Orientadores: Manoel Barros Bertolo, Linamara Rizzo Battistella / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-10T14:49:39Z (GMT). No. of bitstreams: 1 Magalhaes_EduardodePaiva_D.pdf: 4850874 bytes, checksum: 30c39d8223abecede7d6fcaa1901152c (MD5) Previous issue date: 2007 / Resumo: Objetivo: Avaliar a eficácia de palmilhas em pacientes com artrite reumatóide (AR) utilizando o Índice de Função dos Pés (FFI) durante 6 meses. Estudar a alteração na distribuição da pressão plantar em pés reumatóides após 15 dias em uso de palmilhas. Material e Métodos: Foram avaliados trinta e seis pacientes com AR e dor nos pés e prescritas palmilhas conforme as necessidades individuais. Todos os pacientes foram reavaliados em 30, 90 e 180 dias da avaliação inicial. Em cada consulta foi aplicado FFI e verificados o tempo de utilização das órteses e eventuais efeitos adversos. O Health Assessment Questionaire (HAQ) foi verificado na consulta inicial para avaliar a influência da condição física na evolução do FFI. Quinze mulheres com AR e dor nos pés foram submetidas a avaliação da pressão na superfície plantar pelo programa F-SCAN em avaliação inicial e após 15 dias em uso de palmilhas. Resultados: Durante o estudo os valores do FFI reduziram em todas as sub-escalas (dor, incapacidade e limitação de atividade). Esta redução foi notada no primeiro mês e mantida durante todo o período de avaliação. Os pacientes que utilizaram palmilhas com EVA convencionais (n=28) apresentaram melhores resultados. Pacientes utilizando palmilhas sob molde de gesso (n=8) apresentaram valores mais elevados do FFI na consulta inicial e menor redução deste índice com resultados ainda significantes para as sub-escalas de dor e incapacidade, mas não para limitação de atividade. Efeitos adversos menores foram verificados sem resultar em interrupção do tratamento. Os pacientes utilizaram a palmilha durante um período médio de 7,14 horas por dia durante o primeiro mês sem diferenças significativas nas avaliações subseqüentes. Não foi verificada relação entre o HAQ e a evolução do FFI. Com o uso de palmilhas foi verificada significativa redução dos valores de pressão plantar em ante-pé e retro-pé. Conclusões: As palmilhas foram efetivas como adjuvantes no tratamento de pés reumatóides com redução dos índices de dor, incapacidade e limitação de atividade avaliados pelo FFI, com poucos efeitos adversos. Também proporcionaram melhor distribuição da pressão na superfície plantar com redução dos seus valores em ante-pé e retro-pé / Abstract: Objective: To evaluate the effectiveness of foot orthoses, using the Foot Function Index (FFI), in a group of patients with rheumatoid arthritis (RA) in a period of six months. To compare the foot pressures in rheumatoid patients after the use of foot orthoses during a period of fifteen days. Methods: Thirty-six rheumatoid subjects with foot pain were examined and appropriate foot orthoses were prescribed according to each patient needs. All the patients were evaluated in 30, 90 and 180 days after baseline visit. FFI values, daily wearing time and adverse effects were noted in each appointment. The Stanford Health Assessment Questionnaire (HAQ) was obtained in the initial visit and it was used to evaluate the influence of physical condition on FFI response. Fifteen women with RA and foot pain were also examined and their foot pressure values measured using the F-SCAN program in first appointment and after fifteen days using appropriate insoles. Results: After the use foot orthoses, FFI values decreased in all subscales (pain, disability and activity limitation) for the patients studied. This reduction was noted early, in the first month and maintained during all the trial. Those using EVA (n=28) orthoses presented similar results to the total group. Otherwise, patients with made to measure orthoses (n=8) exhibited higher initial FFI values and worse evolution during the trial, still significant for pain and disability, but not for activity limitation. Minor adverse reactions were noted and none of them required treatment interruption. Orthoses were worn on an average for 7.14 hours in the first month without significant differences in the others visits. There was no relation between HAQ and FFI evolution. The patients using the foot orthoses achieved a significant plantar pressure reduction in forefoot and hindfoot. Conclusions: Foot orthoses were effective as an adjuvant management of rheumatoid foot. They significantly reduced pain, disability and activity limitation accessed by the FFI, with minor adverse effects. They also promote a better plantar pressure distribution and relief in forefoot and hindfoot / Doutorado / Clinica Medica / Doutor em Clínica Médica