Juvenile idiopathic arthritis, JIA, is used as an umbrella term covering a heterogeneous group of chronic arthritis forms in children, many of which have important differences compared to adult arthritis, while others possibly represent similar diseases among children and adults. Classification aims to give a better understanding of the pathogenesis, patterns, disease trajectories and treatment responses. For the juvenile psoriatic arthritis, JPsA, the classification criteria are currently being debated. The distribution of affected joints in JIA differs greatly and it is unknown why some joints appear to be more affected than others. The temporomandibular joint (TMJ) can be affected early in the course of the disease and often the symptoms are mild and without obvious swelling. This thesis has its origin in the Nordic Study Group of Paediatric Rheumatology and the population-based prospective study of 510 children with newly diagnosed JIA included between 1997 and 1999. Totally 440 children were included in the eight-year follow-up, and in the TMJ study 265 patients were examined and underwent cone-beam computed tomography, CBCT, 17 years after onset. After eight years a considerable proportion of the children with definite psoriasis were classified as undifferentiated JIA based on the exclusion criteria in the ILAR classification. Our data also presents the heterogenicity of JPsA and the development over time of clinical variables supporting a psoriatic diathesis, as well as the overlap between JPsA and enthesitis-related arthritis in a group of patients.  We found that extensive symptoms and dysfunctions of the TMJ are seen in JIA 17 years after disease onset, even in patients registered with inactive disease or remission. Individuals with substantial condylar damage on CBCT were found in all JIA categories. The deeper understanding of a chronic disease over time is crucial for research initiatives to improve care as well as for clinical decisions and planning of the health care. Our findings suggest a need for a more appropriate classification of JPsA and also that aspects of TMJ involvement should be included in the general health assessment in JIA.

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.

INTRODUÇÃO: Os receptores Toll-like 2 e 4 (TLR-2 e TLR-4) são capazes de ativar células imunes inatas em resposta a bactérias Gram-positivas e Gram-negativas, respectivamente. Na artrite psoriásica (APs), doença articular inflamatória crônica, fatores genéticos, ambientais e infecciosos parecem estar envolvidos. OBJETIVO: Avaliar as expressões dos receptores: TLR-2; TLR-4; CD114 e do CD116 em monócitos e neutrófilos do sangue periférico de pacientes com APs e adicionalmente a prevalência do HLA-B27. MÉTODOS: Quarenta e cinco pacientes com diagnóstico de APs conforme os critérios CASPAR e 32 indivíduos saudáveis foram estudados. Dentre os 45 pacientes, 27 apresentavam APs ativa (DAS28 > 2,6) e 18 APs inativa (DAS28 < 2,5). A leitura das expressões do TLR-2, TLR-4, CD14, CD66, CD114, CD116 e do HLA-B27 foi realizada por citometria de fluxo no FACSCalibur da marca Becton-Dickson, utilizando anticorpos monoclonais da BD Biosciences, anti-humanos produzidos em murino. Os anticorpos monoclonais (AcMo) para marcar receptores de membrana empregados foram: CD14 conjugado com PerCP-Cy5.5 para marcar população de monócitos; CD66 conjugado com PE e FITC para população de neutrófilos; CD114 para marcar receptor de fator estimulatório de colônias de granulócitos e CD116 para marcar receptor de fator estimulatório de colônia de granulócitos-macrófagos. A análise estatística utilizou o teste U de Mann-Whitney e o teste exato de Fisher. Os valores obtidos em porcentagem foram expressos como média ± intervalo interquartil, de acordo com uma distribuição não-paramétrica, avaliados pelo teste de Shapiro-Wilk. RESULTADOS: Demonstramos aumento de expressão do TLR-2 em monócitos periféricos de pacientes com APs, APs ativa e APs inativa comparados aos controles (p < 0,002; p < 0,001 e p < 0,04, respectivamente). A expressão do TLR-4 foi similar nos pacientes com APs, APs ativa e APs inativa e controles (p < 0,23; p < 0,33 e p < 0,29, respectivamente). A expressão do receptor GCSF (CD114) e do receptor GM-CSF (CD116) foi similar nos pacientes e controles nas populações de monócitos e neutrófilos (p > 0,05). O HLA-B27 foi positivo em 1/3 dos pacientes com APs e 6% dos controles. Nos pacientes HLA-B27+ comparados aos controles HLA-B27+, a porcentagem de expressão do TLR-2 nos monócitos foi significantemente maior (p < 0,004). CONCLUSÃO: O aumento da expressão do TLR-2 em monócitos de pacientes com APs reforça o papel da imunidade inata e sugere que a exposição a bactérias Gram-positivas possa ter um papel na indução da resposta inflamatória nesta doença / INTRODUCTION: Toll-Like receptors 2 and 4 (TLR-2 and TLR-4) are able of activating innate immune cells in response to Gram-positive and Gram-negative bacteria, respectively. In Psoriatic Arthritis (APs), chronic inflammatory joint disease and genetic, environmental and infectious factors seems to be involved. OBJECTIVES: Evaluate expressions of TLR-2; TLR-4; CD114 and CD116 receptors in monocytes and neutrophils from peripheral blood patients with APs and additionally the prevalence of HLA-B27. METHODS: Forty five patients diagnosed with APs according with CASPAR criteria and 32 health individuals were studied. Among the 45 patients, 27 presented active APs (DAS28 > 2,6) and 18 inactive APs (DAS28 < 2,5). The evaluation of the TRL-2, TLR-4, CD14, CD66, CD114, CD116 and HLA-B27 expressions was held by flow cytometry in FACSCalibur from Becton-Dickson, utilizing BD Biosciences\' monoclonal antibodies, anti-human produced in mice. The monoclonal antibodies (AcMo) used to mark membrane receptors were: CD14 in conjunction with PerCP-Cy 5.5 to mark population of monocytes; CD66 in conjunction with PE and FITC for population of neutrophils; CD114 to mark stimulatory factor receptor for granulocyte colonies and CD116 to mark stimulatory factor receptor for granulocyte-macrophage colony. The statistical analysis utilized Mann-Whitney\'s U test and Fisher\'s exact test. The values obtained as percentages were expressed as median ± interquartile range, consistent with a non-parametrical distribution, assessed by Shapiro-Wilk\'s test. RESULTS: Increased expression of TLR-2 in peripheral monocytes of patients with APs, active APs and inactive APs compared to controls (p < 0.002; p < 0.001 and p < 0.04, respectively). TLR-4 expression was similar in patients with APs, active APs and inactive APs and controls (p < 0.23; p < 0.33 and p < 0.29 respectively). The expression of the G-CSF (CCD114) receptor and GM-CSF (CD116) receptor were similar in patients and controls in populations of monocytes and neutrophils (p > 0.05). HLA-B27 was positive in 1/3 of the patients with APs and 6% of the controls. The percentage of expression of TLR-2 in HLA-B27 + patients compared to HLA-B27 + controls was significantly higher (p < 0.004). CONCLUSION: Increased of TLR-2 receptors expression in patients with APs monocytes reinforces the role of innate immunity and suggests that the exposure to Gram-positive bacteria may have a role in the induction of the inflammatory response in this diseases

INTRODUÇÃO: Os receptores Toll-like 2 e 4 (TLR-2 e TLR-4) são capazes de ativar células imunes inatas em resposta a bactérias Gram-positivas e Gram-negativas, respectivamente. Na artrite psoriásica (APs), doença articular inflamatória crônica, fatores genéticos, ambientais e infecciosos parecem estar envolvidos. OBJETIVO: Avaliar as expressões dos receptores: TLR-2; TLR-4; CD114 e do CD116 em monócitos e neutrófilos do sangue periférico de pacientes com APs e adicionalmente a prevalência do HLA-B27. MÉTODOS: Quarenta e cinco pacientes com diagnóstico de APs conforme os critérios CASPAR e 32 indivíduos saudáveis foram estudados. Dentre os 45 pacientes, 27 apresentavam APs ativa (DAS28 > 2,6) e 18 APs inativa (DAS28 < 2,5). A leitura das expressões do TLR-2, TLR-4, CD14, CD66, CD114, CD116 e do HLA-B27 foi realizada por citometria de fluxo no FACSCalibur da marca Becton-Dickson, utilizando anticorpos monoclonais da BD Biosciences, anti-humanos produzidos em murino. Os anticorpos monoclonais (AcMo) para marcar receptores de membrana empregados foram: CD14 conjugado com PerCP-Cy5.5 para marcar população de monócitos; CD66 conjugado com PE e FITC para população de neutrófilos; CD114 para marcar receptor de fator estimulatório de colônias de granulócitos e CD116 para marcar receptor de fator estimulatório de colônia de granulócitos-macrófagos. A análise estatística utilizou o teste U de Mann-Whitney e o teste exato de Fisher. Os valores obtidos em porcentagem foram expressos como média ± intervalo interquartil, de acordo com uma distribuição não-paramétrica, avaliados pelo teste de Shapiro-Wilk. RESULTADOS: Demonstramos aumento de expressão do TLR-2 em monócitos periféricos de pacientes com APs, APs ativa e APs inativa comparados aos controles (p < 0,002; p < 0,001 e p < 0,04, respectivamente). A expressão do TLR-4 foi similar nos pacientes com APs, APs ativa e APs inativa e controles (p < 0,23; p < 0,33 e p < 0,29, respectivamente). A expressão do receptor GCSF (CD114) e do receptor GM-CSF (CD116) foi similar nos pacientes e controles nas populações de monócitos e neutrófilos (p > 0,05). O HLA-B27 foi positivo em 1/3 dos pacientes com APs e 6% dos controles. Nos pacientes HLA-B27+ comparados aos controles HLA-B27+, a porcentagem de expressão do TLR-2 nos monócitos foi significantemente maior (p < 0,004). CONCLUSÃO: O aumento da expressão do TLR-2 em monócitos de pacientes com APs reforça o papel da imunidade inata e sugere que a exposição a bactérias Gram-positivas possa ter um papel na indução da resposta inflamatória nesta doença / INTRODUCTION: Toll-Like receptors 2 and 4 (TLR-2 and TLR-4) are able of activating innate immune cells in response to Gram-positive and Gram-negative bacteria, respectively. In Psoriatic Arthritis (APs), chronic inflammatory joint disease and genetic, environmental and infectious factors seems to be involved. OBJECTIVES: Evaluate expressions of TLR-2; TLR-4; CD114 and CD116 receptors in monocytes and neutrophils from peripheral blood patients with APs and additionally the prevalence of HLA-B27. METHODS: Forty five patients diagnosed with APs according with CASPAR criteria and 32 health individuals were studied. Among the 45 patients, 27 presented active APs (DAS28 > 2,6) and 18 inactive APs (DAS28 < 2,5). The evaluation of the TRL-2, TLR-4, CD14, CD66, CD114, CD116 and HLA-B27 expressions was held by flow cytometry in FACSCalibur from Becton-Dickson, utilizing BD Biosciences\' monoclonal antibodies, anti-human produced in mice. The monoclonal antibodies (AcMo) used to mark membrane receptors were: CD14 in conjunction with PerCP-Cy 5.5 to mark population of monocytes; CD66 in conjunction with PE and FITC for population of neutrophils; CD114 to mark stimulatory factor receptor for granulocyte colonies and CD116 to mark stimulatory factor receptor for granulocyte-macrophage colony. The statistical analysis utilized Mann-Whitney\'s U test and Fisher\'s exact test. The values obtained as percentages were expressed as median ± interquartile range, consistent with a non-parametrical distribution, assessed by Shapiro-Wilk\'s test. RESULTS: Increased expression of TLR-2 in peripheral monocytes of patients with APs, active APs and inactive APs compared to controls (p < 0.002; p < 0.001 and p < 0.04, respectively). TLR-4 expression was similar in patients with APs, active APs and inactive APs and controls (p < 0.23; p < 0.33 and p < 0.29 respectively). The expression of the G-CSF (CCD114) receptor and GM-CSF (CD116) receptor were similar in patients and controls in populations of monocytes and neutrophils (p > 0.05). HLA-B27 was positive in 1/3 of the patients with APs and 6% of the controls. The percentage of expression of TLR-2 in HLA-B27 + patients compared to HLA-B27 + controls was significantly higher (p < 0.004). CONCLUSION: Increased of TLR-2 receptors expression in patients with APs monocytes reinforces the role of innate immunity and suggests that the exposure to Gram-positive bacteria may have a role in the induction of the inflammatory response in this diseases

Psoriatic arthritis (PsA) is an inflammatory joint disease associated with psoriasis. PsA has a heterogeneous pattern, expressed by different manifestations such as mild mono-oligoarthritis or very severe, erosive and destructive polyarthritis. Measurable inflammatory activity is not always prominent. The aetiology is unknown but genetic factors are believed to be of importance. The pattern of inheritance is proposed to be polygenic. The aim of this study was to estimate the prevalence of joint and axial manifestations, characterise the disease in relation to inflammatory and genetic markers, and to identify disease susceptibility gene(s) for PsA in patients from northern Sweden. All patients from the city of Umeå (n=276), selected from a community and hospital based psoriasis register (n=1737) at the Dept of Dermatology, were invited to a prevalence study. Two hundred-two patients were examined and 97 (48%) had inflammatory manifestations such as peripheral arthritis, axial disease, undifferentiated spondylarthropathy (uSpA) and enthesopathies. Of the 67 patients (33 %) with peripheral arthritis and/or axial disease, 30 were not previously diagnosed. The association of clinical manifestations and potential markers of aggressive joint disease with HLA associations were analysed in 88 patients with PsA. We were not able to confirm findings of other groups reporting strong association with several HLA-antigens. The prevalence of HLA-B17, B37 and B62 was increased compared with controls, but the strongest predictive factors among our patients for an aggressive disease, in a multiple logistic analysis, were polyarthritic disease and distal interphalangeal engagement. In order to investigate for disease susceptibility genes, five genetic loci were analysed with microsatellites and single nucleotide polymorphisms in an association study of 120 patients with PsA. There was a significant association with the TNFB locus on chromosome 6p but not with any other loci examined; 1q21 (PSORS4), 3q21 (PSORS5), 8q24 and CTLA4. When stratifying for the TNFB alleles the association was confined to allele 123. In a subgroup of patients who were HLA-typed (n=83), we were not able to verify linkage disequilibrium with the TNFB allele 123 and the HLA antigens; B17, B27, B37, B62 or Cw*0602. The presence of renal abnormalities was evaluated as a manifestation of systemic inflammation in 73 patients with PsA. Renal abnormalities defined as decreased creatinine-clearance (≤ mean - 2SD) and/or urinary albumin &gt;25 mg/24 h was found in 23% of the patients. The predictive factors for renal abnormalities was inflammatory activity (ESR &gt; 25 mm/h and/or CRP &gt;15 mg/L) indicating a systemic effect in some of the patients. In conclusion, we found high prevalence of inflammatory manifestations in patients with psoriasis. There was no strong association between PsA and HLA antigens and predictive factors for aggressive disease were polyarthritic disease and DIP joint engagement. The TNFB locus was associated with PsA and there were no linkage disequilibrium with the HLA antigens B17, B27, B62 or Cw*0602. There were evidence for systemic effects as renal abnormalities in patients with PsA and measurable inflammatory activity.

Το CD40L είναι ένα συνδιεγερτικό μόριο και αποτελεί πρώιμο δείκτη ενεργοποίησης του Τ λεμφοκυττάρου. Υπάρχουν δεδομένα που υποστηρίζουν την υπόθεση ότι τα ενεργοποιημένα Τ λεμφοκύτταρα πιθανώς παίζουν ρόλο στην παθογένεια της ψωριασικής αρθρίτιδας (ΨΑ). Μελετήσαμε συνολικά 12 ασθενείς με ΨΑ, 6 ασθενείς με ρευματοειδή αρθρίτιδα (ΡΑ) και 4 υγιείς εθελοντές. Υπολογίσαμε την έκφραση του CD40L στην επιφάνεια των Τ λεμφοκυττάρων με κυτταρομετρία ροής σε κατάσταση ηρεμίας και μετά από διέγερση με ΡΜΑ/ιονομυκίνη. Επίσης μελετήσαμε την ανασταλτική δράση της κυκλοσπορίνης στην επαγόμενη έκφραση του CD40L. Η έκφραση του CD40L ήταν σημαντικά αυξημένη στην επιφάνεια των Τ λεμφοκυττάρων των ασθενών με ΨΑ, ειδικότερα αυτών με ενεργό νόσο, σε σύγκριση με τους υγιείς εθελοντές και τους ασθενείς με ΡΑ (μέσο ποσοστό των CD3+CD40L+ κυττάρων: 23.74%, 11.59% και 9.57% για τους ασθενείς με ενεργό ΨΑ, ασθενείς με ΡΑ και υγιείς εθελοντές αντίστοιχα). Η αναστολή από την κυκλοσπορίνη της επαγόμενης έκφρασης του CD40L ήταν εξίσου αποτελεσματική και στις 3 ομάδες μελέτης. Συμπερασματικά αναφέρουμε ότι το CD40L υπερεκφράζεται στη επιφάνεια των Τ λεμφοκυττάρων ασθενών με ενεργό ΨΑ μετά από in vitro διέγερση. Το γεγονός αυτό ενισχύει την άποψη ότι ο άξονας CD40- CD40L παίζει σημαντικό ρόλο στη παθογένεια της ΨΑ και κατά συνέπεια θεραπείες που να στοχεύουν εκλεκτικά αυτόν τον άξονα θα μπορούσαν να δοκιμαστούν στην ΨΑ. / CD40L is a costimulatory molecule and an early activation marker of T lymphocytes. Evidence supports the hypothesis that activated T cells may play a role in the pathogenesis of psoriatic arthritis (PsA). We examined the levels of CD40L expression on resting T cells from 12 patients with PsA, 6 patients with rheumatoid arthritis (RA) and 4 healthy volunteers, and following stimulation with phorbol myristate acetate (PMA)/ionomycin. The inhibitory effect of cyclosporine A (CsA) on the induced expression of CD40L was also evaluated. This expression was significantly increased on the cell surface of T cells from patients with PsA, particularly those with active disease, when compared to normal individuals and patients with RA (mean percentages of CD3+ CD40L+ cells: 23.74%, 11.59% and 9.57% for patients with active PsA, patients with RA and healthy volunteers, respectively). CsA-mediated inhibition of CD40L induction was equally effective in all study groups. In conclusion, we report herein that CD40L is overexpressed in patients with active PsA. This may indicate that CD40L with its counter-receptor may be crucially involved in the pathogenesis of PsA. Consequently, therapies specifically targeting this pair may be worth testing.

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.

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.

No description available.

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