Introdução/Objetivos: O impacto da artrite psoriásica (APso) percebido pelo paciente que vive fora do continente europeu ainda é pouco conhecido, uma vez que quase todos os estudos qualitativos sobre o tema recrutaram populações europeias. O presente trabalho tem como objetivo avaliar o impacto físico, emocional, profissional e social da APso em pacientes brasileiros. Também se compara o impacto da APso percebido por pacientes franceses e brasileiros. Métodos: Um estudo qualitativo foi realizado em dois hospitais universitários no Brasil e na França; pacientes ambulatoriais que preenchiam critérios de classificação para APso participaram de entrevistas individuais na linguagem local. O tamanho da amostra foi definido através do princípio de saturação; as entrevistas foram gravadas, os dados foram transcritos e uma análise de conteúdo foi realizada. Resultados: Quinze pacientes foram entrevistados no Brasil e 13 na França. A média de duração da doença foi de 16,.5 ± 12,5 anos (variando de 8 meses até 47 anos) e 14,4 ± 8,4 anos (variando de 12 meses a 29 anos), para brasileiros e franceses, respectivamente. Medicamentos biológicos foram prescritos para 33% dos brasileiros (N=5) e 23% dos participantes franceses (N=3). Um amplo impacto foi reportado: 67 categorias emergiram durante as entrevistas e foram agrupadas em 24 domínios de saúde. O impacto da doença percebido pelos brasileiros e franceses foi globalmente similar: 67% dos domínios foram comuns a ambas as nacionalidades. Apesar do impacto percebido pelas duas amostras ser semelhante, alguns domínios importantes para os brasileiros e ainda pouco estudados nesta população como desordens do sono, disfunção sexual e fadiga foram identificados. Este trabalho também expõe o impacto emocional, social e profissional do preconceito causado pela psoríase em pacientes brasileiros. Conclusão: Brasileiros e franceses com APso percebem um amplo e similar impacto da doença, que transcende os aspectos físicos. Domínios importantes para pacientes que vivem fora da Europa e que permanecem pouco estudados podem ser reconhecidos através da metodologia qualitativa. / Background: The patient-perceived impact of Psoriatic Arthritis (PsA) outside the European background is still few studied since almost all qualitative studies on the subject have been performed in European populations. This work aimed to evaluate the physical, emotional, professional and social impact of PsA in Brazilian patients. It also compares patient-perceived impact of PsA between Brazilian and French subjects. Methods: A qualitative study was conducted in two university hospitals in Brazil and France; outpatients fulfilling classification criteria for PsA participated in individual interviews in the local language. The sample size was defined by saturation; interviews were recorded, data were transcribed and content analysis was performed. Results: Fifteen patients were interviewed in Brazil and 13 in France. Mean disease duration was 16.5 ± 12.5 years (range: 8 months to 47 years) and 14.4 ± 8.4 years (range 12 months to 29 years), for Brazilian and French subjects, respectively. Biologic drugs were prescribed to 33% of Brazilians (N=5) and 23% of French participants (N=3). A broad impact was perceived: 67 categories of impact emerged from the interviews and were grouped in 24 health domains. The impact of disease perceived by Brazilian and French participants was globally similar: 67% of domains were common to both nationalities. Despite the similar impact among the samples, some domains important for Brazilian patients and still few studied in this population as sleep disorders, sexual dysfunction and fatigue were identified. This work also exposed the emotional, social and professional impact of prejudice due to psoriasis in Brazilian patients. Conclusions: Brazilian and French subjects living with PsA perceive a broad and similar impact of disease which goes far beyond physical aspects. Domains important to patients living outside Europe and which remain few studied can be recognized through qualitative methodology.

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Objetivo: evaluar la eficacia y la seguridad del tofacitinib para el tratamiento de segunda línea en pacientes con artritis psoriásica. Metodología: La búsqueda bibliográfica se llevó a cabo en Medline y Cochrane Library, utilizando los términos MeSH: “Psoriatic arthritis” AND “Tofacitinib”, se realizó un meta-análisis de efectos aleatorios para calcular los riesgos relativos (RR), diferencias de medias estandarizadas (DME) y sus respectivos intervalos de confianza al 95% (IC95%) a través del software de Review Manager, versión 5.2. Los criterios de inclusión utilizados fueron: diseño de tipo ensayo clínicos aleatorizado o estudios de cohorte, uso de tofacitinib como segunda línea de tratamiento, población mayor o igual a 18 años, inclusión de los desenlaces seleccionados, e idioma. Resultados: se incluyó tres ensayos clínicos aleatorizados, en población adulta con artritis psoriásica activa según CASPAR, que compararon tofacitinib frente a placebo o adalimumab. En un periodo de seguimiento de tres meses, tofacitinib demostró eficacia frente a placebo en la mejora del compromiso articular (ACR20) tanto en dosis de 5 mg (RR: 1,77; IC95%: 1,39 a 2,44) como en dosis de 10 mg (RR: 1,89; IC95%: 1,49 a 2,39). Se encontró mejora significativa en la discapacidad a dosis de 10 mg (DME: -4,27; IC95%: -4,60 a -3,94) y en la calidad de vida. Frente a adalimumab, tofacitinib de 5mg fue inferior en los resultados de eficacia, mientras que la dosis de 10mg fue superior. Con relación a la seguridad, no se encontró diferencias en la presencia de algún efecto adverso, efecto adverso severo ni en discontinuación por efectos adversos. Conclusión: tofacitinib en dosis de 5mg y 10mg mostró ser eficaz en el control del compromiso articular y mejora de la calidad de vida frente a placebo, en el tratamiento de segunda línea de artritis psoriásica, con similar perfil de seguridad. Número de registro de revisión sistemática en prospero: CRD42019122245. / Objective: to evaluate the efficacy and safety of tofacitinib for second-line treatment in patients with psoriatic arthritis. Methodology: he bibliographic search was carried out in Medline and Cochrane Library, using the MeSH terms: “Psoriatic arthritis” AND “Tofacitinib”, a random effects meta-analysis was carried out to calculate the relative risks (RR), standardized mean differences ( SMD) and their respective 95% confidence intervals (95% CI) through Review Manager software, version 5.2. The inclusion criteria used were: design of a randomized clinical trial or cohort studies, use of tofacitinib as a second line of treatment, population older than or equal to 18 years, inclusion of selected outcomes, and language. Results: three randomized clinical trials were included, in an adult population with active psoriatic arthritis according to CASPAR, which compared tofacitinib with placebo or adalimumab. In a three-month follow-up period, tofacitinib demonstrated efficacy compared to placebo in improving joint involvement (ACR20) both in 5 mg doses (RR: 1.77; 95% CI: 1.39 to 2.44) and in 10 mg dose (RR: 1.89; 95% CI: 1.49 to 2.39). A significant improvement was found in disability at a dose of 10 mg (SMD: -4.27; 95% CI: -4.60 to -3.94) and in quality of life. Compared to adalimumab, the 5mg tofacitinib was lower in efficacy results, while the 10mg dose was higher. Regarding safety, no differences were found in the presence of any adverse effect, severe adverse effect, or in discontinuation due to adverse effects. Conclusion: tofacitinib in doses of 5mg and 10mg was shown to be effective in controlling joint involvement and improving quality of life compared to placebo, in the second-line treatment of psoriatic arthritis, with a similar safety profile. Prospero Systematic Review Registry Number: CRD42019122245. / Tesis

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v anglickém jazyce Introduction: No information was known about frequency of common inflammatory disorders in rheumatology in the Czech Republic. Aims of the study: To estimate the standardized annual incidence (INC) and point prevalence (PREV) of six diseases (rheumatoid arthritis-RA, juvenile idiopathic arthritis-JIA, gout, psoriatic arthritis-PsA, ankylosing spondylitis-AS, reactive arthritis-ReA) in a population-based study in two regions of the Czech Republic (CR). Methods: INC: Incident cases were registered on condition that the definite diagnosis was confirmed according to existing classification criteria during the study period. PREV was studied on the basis of identification of established diagnoses at a time point. Crude rates were standardized for age and sex. Results: Both INC and PREV are shown per 100.000 inhabitants. RA INC:31 (95%CI 20-42), PREV:610 (95%CI 561-658). Gout-INC:41 (95%CI 28-53), PREV:300 (95% CI 266-334). JIA-INC: 13 (95% CI 1-20), PREV:140 (95%CI 117-280). PsA-INC:3,6 (95% CI 1-8), PREV:49 (95%CI 40-60). AS-INC:6 (95% CI 3-11), PREV:94 (95% CI 94-109). ReA-INC:9 (95% CI 6-15), PREV:91 (95% CI 78-106). Conclusion: This is the first population-based study estimating annual incidence and prevalence rates of the most common rheumatological disorders in the Czech...

In order to convince, one must know which arguments are most suitable for the specific situation. But even if you think you know how others will react to your arguments, you may be wrong. Therefore, the purpose of this paper is to find out a way of examining to what extent informative text take account to the subjective views of their addressees. The theoretical framework is Blitzer's theory of the rhetorical situation, pragmatic theory of speech acts and their presuppositions, Burk´s theory of consubstantiality and phenomenographic theory of subjective perceptions. Methodologically, phenomenography has also been used as a guideline for selecting informants, collecting data and processing the interviews. The material analyzed consists interviews with four persons suffering from psoriasis, a brochure addressed to an unspecified audience with the same problem plus an interview with a spokesperson for the Swedish Psoriasis Association. The analysis reveals a clear difference in certain important respects between the subjective views of the intended reader and the implied addressees of the text, i.e. a lack of consubstantiality between sender and receiver. This points to a rhetorical problem when addressing an unknown audience without exploring their specific perceptions of concepts related to the transmitted information, a problem which may be grasped and perhaps to some extent even solved by applying a method similar to the one used in this study.

Rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis belong among serious disorders, that effect joints and connective tissue. The patients suffer from pain and stiffness. Disease modifying drugs are an important part in the management of rheumatical disorders. When disease modifying drugs are failing, than biologic treatment is applied. For biologic treatment are registred etanercept (Enbrel), adalimumab (Humira), rituximab (MabThera), abatacept (Orencia) and infliximab (Remicade). In the Czech Republic was established the National registry of rheumatic disorders. There is a need of long term observations of patients, who have biologic treatment, to evaluate safety and socioeconomic data of the biologic treatment.

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No description available.

Introdução: A psoríase é uma doença sistêmica crônica, inflamatória e imuno- mediada, que afeta a pele, vasos e sistema osteomuscular. A inflamação é um fator de risco importante para a aterosclerose, e a psoríase está associada com risco aumentado de dislipidemia, diabetes, hipertensão, obesidade e esteato-hepatite não alcoólica. No entanto, o impacto da inflamação crônica sistêmica sobre a saúde vascular e aterosclerose permanece mal compreendido. Objetivos: Analisar a associação entre psoríase e aterosclerose subclínica com uma medição não invasiva, avaliada no ramo das artérias carótidas, usando a espessura médio-intimal (IMTc). O objetivo secundário foi comparar a IMTc entre os subgrupos psoríase: leve, moderada à psoríase/grave e artropática, com o grupo controle. Métodos: Neste estudo caso-controle transversal, 221 pacientes com psoríase (31,2% psoríase leve, 41,6% psoríase moderada/grave e 31,2% psoríase artropática) foram comparados com um grupo de 5.061 controles existentes recrutados a partir de um inquérito anterior (ELSA-Brasil HU-USP). Os critérios de inclusão compreendem os seguintes fatores: acima de 40 anos de idade para mulheres e 35 anos para homens; psoríase diagnosticada e clinicamente ativa, pelo menos há dois anos. Os critérios de exclusão foram: gravidez, presença de neoplasia, gota, artrite reumatóide e lúpus eritematoso sistêmico. Todos os participantes foram submetidos a exame médico, exame clínico e dados antropométricos recolhidos, bem como amostras de sangue para análise laboratorial. Em seguida, foram realizados exame de ultrassonografia das artérias carótidas direita e esquerda a fim de determinar IMTc. Ambos os lados analisados com média dos valores; quando aumentados foram utilizadas como um indicador da aterosclerose subclínica. Resultados: No grupo psoríase, o tempo médio de doença foi de 16 (± 13) anos. Em relação ao IMT da carótida (média dos lados direito e esquerdo), não observamos valores aumentados no grupo de psoríase, em comparação com o grupo controle, com os dados crus (P = 0,24 e P = 0,83, IMT esquerda e IMT direita, respectivamente). No entanto, quando o ajuste por sexo e idade (P = 0,038 e P < 0,0001, IMT para a esquerda e direita, respectivamente) e um ajuste multivariado para o risco cardiovascular, uma diferença significativa é encontrada (P = 0,028 e P < 0,0001, IMT esquerda e IMT direita, respectivamente) com valores mais elevados da carótida IMT no grupo de psoríase do que no grupo controle. Em consonância com isso, não foram observadas diferenças na IMT entre ameno, sub-grupos artrite psoriática moderado-grave e grupo controle (P = 0,50 e P = 0,52, respectivamente). Hipertensão, Hs CRP, IMC, HDL e LDL foram maiores nos pacientes com psoríase, em comparação com os controles (ambos p < 0,001). Conclusões: Na coorte brasileira, pacientes com psoríase apresentaram um perfil mais grave de fatores de risco cardiovascular do que os controles, em função do aumento da espessura da parede da artéria carótida encontrada nesses pacientes. O papel preciso da inflamação sistêmica crônica e outros fatores sobre a progressão da doença e comorbidades devem ainda ser elucidados . / Introduction: Psoriasis is a chronic systemic immune-mediated inflammatory disease affecting skin, vessels and osteomuscular system. Inflammation is an important risk-factor for atherosclerosis and psoriasis is associated with increased risk for dislipidemia, diabetes, hypertension, obesity and non-alcoholic steatohepatitis. However, the impact of chronic systemic inflammation on vascular health and atherosclerosis remains poorly understood. Objectives: To examine the association between psoriasis and subclinical atherosclerosis assessed at the carotid artery branch using a non-invasive measurement of the intima-media thickness (IMTc). The secondary objective was to compare the IMTc between psoriasis subgroups: mild, moderate / severe psoriasis and arthropathica with control group. Methods: In this cross-sectional case-control study, 221 psoriasis patients (31.2% mild psoriasis, 41.6% moderate-severe psoriasis and 31.2% arthritic psoriasis) were compared with a group of 5,061 existing controls recruited from a previous investigation (ELSA-Brasil HU-USP). Inclusion criteria were: 40 y of age for women and 35 y of age for men; psoriasis diagnosed and clinically active for at least 2 years. Exclusion criteria were: pregnancy, neoplasia, gout, rheumatic arthritis and systemic lupus erythematosus. All participants were submitted to medical screening, clinical examination and had anthropometric data collected as well as blood samples for laboratorial analysis. Then, they undertook an ultrasound scan of the right and left carotid arteries in order to determine IMTc. Both sides were averaged and increased values were used as an indicator of subclinical atherosclerosis. Results: The psoriasis group the mean disease time was 16±13 years. In relation to the carotid IMT (right and left sides averaged), we did not observe increased values in the psoriasis group as compared to the control group, with crude data (P = 0,24 and P = 0,83, IMT left and IMT right respectively). However, when adjusting by sex, age (P = 0,038 and P < 0,0001, IMT left and IMT right respectively) and a multivariate adjustment for cardiovascular risk, a significant difference is found (P = 0,028 and P < 0.0001, IMT left and IMT right respectively) with higher carotid IMT values in the psoriasis group than in the control group. In line with this, no differences were observed in the IMT between mild, moderate-severe, psoriatic arthritis sub-groups and control group (P = 0.50 e P = 0.52, respectively). Hypertension, Hs CRP, BMI, HDL and LDL were higher in psoriasis patients as compared to controls (both p < 0.001). Conclusions: In the Brazilian cohort, psoriasis patients presented a more severe profile of cardiovascular risk factors than controls, with increased carotid arterial wall thickness being found in these patients. The precise role of chronic systemic inflammation and other factors on disease progression and comorbidities are yet to be elucidated