Autor: Bc. Veronika Sýkorová Title: Comparative analysis of the effect on disease-modifying drugs and biological therapy in functional ability in patients with rheumatoid arthritis. Objective: The aim of the thesis is to compare the effect of disease-modifying drugs and biological therapy on quality of life using the disability index, which is achieved by evaluating the HAQ, grip strength the small muscles of the hand, which is tested a hand dynamometer and standing stability, which is detected by measuring on stabilometric platform. Methods: This is a pilot study using subjective and objective examination. Stabilometric and dynamometric examination and the Czech version of the Stanford Health Assessment Questionnaire validated by Rheumatology Institute in Prague 2010 were used to the analysis. Evaluation of the collected data was done using two-way analysis of variance with repetition. Results: Biological therapy and disease-modifying antirheumatic drugs have significant impact on quality of life, the strength of the small muscles of the hand and standing stability in patients with rheumatoid arthritis. Disease-modifying antirheumatic drugs have reached significant results than the biological therapy in quality of life, forces the small muscles of the right hand and standing stability. Biological...

Two novel B cell populations were characterized in peripheral blood of patients with common variable immunodeficiency and healthy controls were observed using flow cytometry in the study supported by the grant IGA MZ ČR NKT11414-3. These B cell populations were defined as CD19+ CD27- CD21+ CD38low CD24+ IgM+ FO I and CD19+ CD27- CD21+ CD38low CD24++ IgM++ cells. Since none of found populations has ever been described, the aim of this thesis was to characterize these populations with focus on analysis of variable regions of the heavy chains of immunoglobulins and genes coding proteins participating in the process of VHDHJH formation (Rag 1, Rag 2, and TdT) produced by cells of these populations. Flow cytometry, single cell sorting, single-cell RT-PCR, IgVH, Rag 1, Rag 2, and TdT specific PCR amplification and cycle sequencing were employed to perform the molecular analysis in individual B lymphocytes. Both populations in two patients with common variable immunodeficiency, two healthy controls, and in two patients with autoimmune diseases - rheumatoid arthritis and systemic lupus erythematosus (as the disease control) - were examined. Finally, the statistical analysis was used to evaluate the differences in expression of variable regions of the heavy chains of immunoglobulins and in Rag1 and 2, and...

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

Charles University in Prague Faculty of Pharmacy in Hradec Králové Department of Pharmacology & Toxicology Student: Jana Jeřábková Supervisor: Doc. PharmDr. Petr Pávek, Ph.D. Title of diploma thesis: Interaction of selected anthocyanidins with farnesoid X receptor Human farnesoid X receptor (FXR) is a member of nuclear receptor superfamily that act as ligand-activated transcription factors. FXR binds to specific regulatory DNA regions and induces expression of many target genes. These regulated genes are involved in bile acid metabolism and transport, maintaining blood lipids, liporoteins and glucose homeostasis and also contribute to maintain intestinal bacterial balance, hepatoprotection and liver regeneration. The interest of recent studies is to test the range of FXR ligands for treatment and prevention of many diseases such as cholestais, cholesterol gallstone disease, steato-hepatitis, dyslipidemia, atherosclerosis, type 2 diabetes mellitus, metabolic syndrome, liver cancer and other forms of cancer such as breast cancer. In this experimental diploma thesis we are focused on testing of potencial ligands of human farnesoid X receptor from the group of natural plant pigments anthocyanidins (cyanidin, delphinidin, malvidin, pelargonidin, peonidin and petunidin) using the human hepatoma cell line...

Sammanfattning Bakgrund: Kronisk ledgångsreumatism eller Reumatoid Artrit (RA) är en kronisk inflammatorisk ledsjukdom och är den vanligaste artritsjukdomen vars huvudsymtom är ledvärk. RA finns i alla folkgrupper, dock med varierande prevalens. I Skandinavien ligger prevalensen på ca 0,7 %. Etnologin till RA är en blandning av genetiska och omgivningsrelaterade faktorer. Att leva med RA påverkar patienten fysiskt, känslomässigt, psykologiskt och även socialt vilket leder till att hela livssituationen påverkas. Syfte: Syftet med litteraturstudien var att beskriva erfarenheter av sjuksköterskeledd mottagning hos patienter med reumatoid artrit samt beskriva undersökningsgruppen i de inkluderade artiklarna. Metod: En litteraturstudie med beskrivande design. Huvudresultat: Patienternas erfarenhet av sjuksköterskeledd mottagning var möten i en varm, vänlig och familjär atmosfär. Vården beskrevs som personcentrerad och kompetent och var baserad utifrån varje individs speciella behov. Sjuksköterskans specialistkunskaper värderades högt och uppgavs skapa en känsla av trygghet hos patienten. Den sjuksköterskeledda mottagningen upplevdes som lättillgänglig, flexibel och skapade kontinuitet i vården. Tillgängligheten medförde också att patienten visste när och hur de skulle kontakta sjuksköterskan. Patientens erfarenhet var att en god kommunikation med vårdpersonalen, gav en ömsesidig respekt och ingav patienten ökat förtroende. Slutsats: Slutsatsen av denna studie är att sjuksköterskeledd mottagning kan skapa ett mervärde för patientens omvårdnad. Den erbjudna vården representerade för deltagarna trygghet, hopp och förtroende. För att ett mervärde ska skapas är det av största vikt med god kommunikation och relationskapande, vilket i sin tur ger trygghet och skapar en grundläggande möjlighet för hälsofrämjande omvårdnad. / Abstract Background: Chronic arthritis rheumatism or rheumatoid arthritis (RA) is a chronic inflammatory joint disease and is the most common arthritis disease, in which headache is joint pain. RA is present in all populations, with varying prevalence. In Scandinavia, the prevalence is approximately 0.7%. The ethnology of RA is a combination of genetic and environmental factors. Living with RA affect the patient physically, emotionally, psychologically and socially, meaning that the whole life situation is affected. Aim: The purpose of the literature study was to describe the experiences of nurse-led clinics for patients with rheumatoid arthritis and to present the study groups described in the articles included. Methods: A descriptive literature study Main results: Patients' experiences of nurse-led clinics were encounters in a warm, friendly and familiar atmosphere. The care was described as person-centered and competent provided and based on each individual's special needs. The nursing specialist skills were highly valued and described to create a sense of security for the patient. The nurse-led clinic was reported readily available, flexible and to create stability in the care. The accessibility also meant that the patients were aware of when and how to contact the nurse. The patient's experience was that good communication with the healthcare staff provided a mutual respect and instilled an increased patient confidence. Conclusion: The conclusion of this study was that nurse-led clinics could add value for the patient nursing care. This offered care represented familiarity, hope and confidence for the patients. To achieve added value, good communication and relationship are of the utmost importance, which in turn provide security and create a fundamental possibility in health-promoting care.

Rheumatoid arthritis (RA) is a worldwide problem representing one of the most prevalent autoimmune diseases in the world. Despite the commonness of the disea- se, its pathogenesis has not been fully described. Immune cells ranging from antigen- presenting cells to T, B and NK cells playing various roles participate in the rheumatic process. In this work we concentrated on NK cells expressing a repertoire of activating and inhibitory receptors which influence their function in health and disease. We focused on the analysis of NK cell function and described its possible modulation by rheumatic autoantigens and multivalent glycodendrimers bearing 4 (GN4C) or 8 (GN8P) N-acetyl glucosamine moieties. The effect on NK cells and the glycosylation pathways was further studied in vitro. Finally, an in vivo study was performed on an animal model of RA - col- lagen-induced arthritis (CIA) to assess the effect of the compounds on clinical develop- ment of the disease and selected immune parameters. Comparison of NK cell cytotoxicity in patients suffering from RA, other inflam- matory diseases and healthy donors showed its impairment particularly in RA patients. Peripheral blood NK cells reacted to GN8P glycoconjugate by inhibition of their effector function in CD161 high-expressing samples. The MGAT5...

A artrite reumatoide (AR) é uma doença inflamatória crônica, caracterizada por inflamação das articulações e se manifesta por inchaço e incapacidade funcional das mesmas. A patologia da doença envolve a produção excessiva de radicais livres pelos neutrófilos ativados, podendo induzir à peroxidação lipídica nas membranas celulares o que leva ao aumento da inflamação. Nesse sentido, o selênio (principal fonte é a castanha-do-brasil) é um importante fator por diminuir a atividade dos hidroperóxidos por meio da ação da enzima antioxidante glutationa peroxidase (GPx). No entanto, estudos que avaliem a associação do estado nutricional relativo ao selênio em pacientes com AR com os biomarcadores do estresse oxidativo e de inflamação são escassos na literatura. Desse modo, a avaliação do efeito potencial in vivo da suplementação com castanha-do-brasil, como fonte de selênio, sobre os parâmetros descritos anteriormente e sua relação com o polimorfismo Pro198Leu no gene da GPx1, em pacientes com artrite reumatoide (AR), vêm a suprir essa lacuna. Inicialmente foi realizada a caracterização da castanha-do-brasil quanto à composição de macronutrientes e teor de selênio. O estudo em pacientes com artrite reumatoide foi de natureza longitudinal. Foram avaliados 46 pacientes com AR, com idade média de 55,2 ± 10,9 anos, atendidos no Setor de Reumatologia da Universidade Federal de São Paulo. O estudo foi dividido em duas fases: antes (T0) e após a suplementação (T1) com 1 nóz de castanha-do-brasil. Foi realizada a avaliação da composição corporal e do consumo alimentar. Além disso, foram avaliados parâmetros bioquímicos relativos ao status de selênio por espectrofotometria de absorção atômica por geração de hidretos; atividades da GPx e SOD com uso de kits comerciais; concentração da GPx1 por kits comerciais, sua expressão gênica (qRT-PCR) e genotipagem do Pro198Leu no referido gene por PCR em tempo real; determinação de 8-isoprostanos por kit comercial, assim como níveis circulantes de fibrinogênio, proteína C reativa, IL-6, IL-10, TNF-α, IL-1β, IL-2, VCAM, ICAM, PAI-1 e sE-selectina pelo ensaio ELISA. O genótipo selvagem (Pro/Pro) foi observado em 57,63% das participantes; 35,59% para as heterozigotas para o alelo variante (Pro/Leu) e 6,78% apresentaram os dois alelos variantes. As pacientes com artrite reumatoide apresentaram baixa ingestão de selênio e, após a intervenção, o consumo aumentou significantemente. Em relação ao status de selênio, houve um aumento em sua concentração no plasma e eritrócitos após o período de intervenção com castanha-do-brasil, assim como na atividade da GPx, na concentração da GPx1 e em sua expressão gênica. Níveis urinários reduzidos de 8-isoprostano e nenhuma alteração quanto à capacidade antioxidante total plasmática e quanto aos marcadores inflamatórios foram observados após o período de intervenção. Por outro lado, houve um aumento nas concentrações séricas das moléculas de adesão celulares. Portanto, pode-se concluir que a suplementação com castanha-do-brasil mostrou-se efetiva em melhorar o estado nutricional relativo ao selênio dos pacientes e os marcadores de estresse oxidativo, todavia a ingestão de 350 µgSe/dia não foi suficiente para promover uma melhora do quadro inflamatório. Além disso, a presença do polimorfismo Pro198Leu modificou as respostas dos indivíduos CT e TT em relação à suplementação, sendo inferior à dos indivíduos CC. / Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by joint inflammation, manifested by swelling and joint impairment. These pathology involves excessive free radicals production by activated neutrophils leading to lipid peroxidation in cell membranes and increased inflammation. Accordingly, selenium (Brazil-nut as main source) is an important factor reducing hydroperoxides through the improvement of glutathione peroxidase (GPx) activity. However, studies evaluating their association with oxidative stress biomarkers and inflammation in RA patients are scarce. Thus, the assessment of the in vivo potential Brazil nut supplementation on the parameters described above and its relationship to the polymorphism Pro198Leu in GPx1 gene in patients with rheumatoid arthritis, come to fill this gap. First of all, we analysed macronutrients and selenium content in Brazil nut. This is a longitudinal study with 46 RA patients attending rheumatologic treatment at Federal University of São Paulo and whose mean age were 55.2 ± 10.9 years. The present study was carried out by two phases, before and after one Brazil ingestion. We evaluated selenium status by spectrophotometry absorption with hydride generation; body composition, SOD, GPx activites, GPx1 concentration and 8- isoprostane levels, using commercial Kits; gene expression by RT-PCR and genotyping using real time PCR. Besides, inflamatory biomarkers were performed (fibrinogen, C reactive protein, IL-6, IL-10, TNF-α, IL-1β, IL-2, VCAM, ICAM, PAI-1 e sE-selectin by ELISA. The wild genotype (Pro/Pro) was observed in 57.63% of the participants, 35.59% were heterozygote for variant allele (Pro/Leu) and 6.78% had two variant alleles. Patients with rheumatoid arthritis had low selenium intake and after the intervention, consumption of this element increased significantly. Selenium status increased significantely after Brazil nut ingestion, as well as GPx activity, GPx1concentration and its gene expression. Reduced urinary levels of 8-isoprostane and no change for total plasma antioxidant capacity and markers for inflammation were observed after the intervention period. On the other hand, there was an increase in serum concentrations of cell adhesion molecules. Therefore, it can be concluded that Brazil-nut supplementation proved to be effective in improving selenium status and markers of oxidative stress in RA patients, however ingestion of 350 µgSe/day wasn\'t enough to ameliorate inflammation. Besides, the presence of Pro198Leu polymorphisms interfere in supllementation response in CT and TT groups, being less responsive than CC ones.

L’arthrose (OA) est un rhumatisme chronique dont la prise en charge médicamenteuse repose principalement sur les antalgiques et anti-inflammatoires, ce qui justifie la nécessité de rechercher d’autres cibles thérapeutiques. L’une de ces cibles potentielles est la galectine 3, une lectine sécrétée dans l’articulation au cours de la pathogenèse de cette maladie. Cette lectine interagit avec ses ligands à la surface des cellules articulaires pour engendrer des réactions inflammatoires et des phénomènes de catabolisme matriciel au niveau des tissus ostéo-articulaires, ce qui en fait une cible intéressante dans le traitement de l’OA. Le 1e objectif de ce projet de recherche est de mieux caractériser les effets biologiques de la galectine 3 sur le métabolisme chondrocytaire. Le 2e objectif est de concevoir des formes tronquées de galectine 3 et le 3e objectif est de démontrer leur potentiel d’inhibiteur de la forme entière de galectine 3 dans l’articulation. Ces travaux montrent que la galectine 3 est un facteur pro-inflammatoire, pro-catabolique mais aussi anti-anabolique dans le chondrocyte. Plusieurs formes tronquées recombinantes de galectine 3 ont été produites. Des tests préliminaires d’activité biologique in vitro démontrent que dans certaines conditions, l’une d’elles inhibe partiellement les effets biologiques de la galectine 3 sur des chondrocytes humains. Ces travaux de recherche constituent la preuve de concept d’un projet global s’inscrivant dans une perspective de thérapie génique pour l’OA / Osteoarthritis (OA) is a chronic rheumatism which drug management is based on antalgic and anti-inflammatory drugs, which requires the need to search for other therapeutic targets. One of these potential targets may be galectin 3, a lectin secreted in the joint during the pathogenesis of the disease. This lectin binds its ligands on the surface of the joint cells and thus, leads to inflammatory reactions and matrix catabolism phenomena, making it an attractive target in the treatment of OA. The 1st aim of our research project was to characterize the biological activity of galectin 3 on chondrocyte metabolism. The 2nd aim was to design and produce several truncated forms of galectin 3. The 3rd aim was to evaluate the presumed galectin 3-inhibiting activity of the truncated forms. This objective is part from the perspective of gene therapy for OA. Our work shows that galectin 3 is a proinflammatory, procatabolic but also an antianabolic factor in chondrocytes. Several recombinant truncated forms of galectin 3 were designed and produced. Preliminary tests of biological activity in vitro show that the chosen truncated lectin partially inhibits the biological activity of galectin-3 on human chondrocytes under a few conditions. This work is the proof of concept of a broader project of which perspective is gene therapy in OA

Submitted by admin tede (tede@pucgoias.edu.br) on 2016-08-17T13:44:18Z No. of bitstreams: 1 Laura Goncalves.pdf: 1283052 bytes, checksum: de5235904a586f99fa9976b0bb8e0e7e (MD5) / Made available in DSpace on 2016-08-17T13:44:18Z (GMT). No. of bitstreams: 1 Laura Goncalves.pdf: 1283052 bytes, checksum: de5235904a586f99fa9976b0bb8e0e7e (MD5) Previous issue date: 2008-08-29 / Patients suffering from rheumatoid arthritis have their quality of life compromised due to the restrictions in their daily life activities, which are caused by the physical limitations brought by the disease. The therapies have the purpose of relieving the pain, minimizing or preventing the preliminary and secondary disabilities caused by the disease and also to enable the patients to monitor themselves. The main objective of this research was to evaluate the effects of the cinesiotherapy on the quality of life of the women with the disease. The study based on a group of women with rheumatoid arthritis diagnosed after the age of 18 by a rheumatologist. Classified in functional degrees II and III, except for the patients with comorbities. The study proposal included three stages: two evaluations of the quality of life of the patient and the therapeutical momentum characterized by the cinesiotherapy applied. The evaluation process consisted of the application a patterned questionnaire to a group of thirty-six women (SF-36). This group was randomly divided into two groups of the same size and then submitted to espcific anamnesis. The women in the group of cases (group I) were evaluated using the information on the SF-36 questionnaire concerning their life quality. And then they went through a program of global cinesiotherapy. After that, these women were evaluated a second time about their quality of life at the end of the period (40 days). The women in the control group (group II) did not go through the physical therapy treatment, but they were evaluated a second time concerning their quality of life. The variables that could interfere with the prognosis and development of the disease were analyzed by the anamnesis: age, time of disease, rheumatoid factor, number of joints, functional degree, VHS, scholarship and medicines, comparing at the two groups, via the test qui-squared and test u-man whitney, using á 0,05 to prove the groups were homogenous. The data from the query S-F36 have been evaluated and submitted at the validation statistic , by using - in case that the test t student , the test u-man whitney and the test wilcoxon In order to be validated, the data in the questionnaires were statistically analyzed using á 0,05. For the evidence from the normality as of each of the variables , it uses - in case that the test as of adherence kologorov smirnov. Confirms - in case that as soon , via the analysis from the statistic significance, than it is to the handling of cinesiotherapy influenced positively the status of life of the patients of the group I(work group). Statistically speaking, we can state that the cinesiotherapy influenced positively the quality of life of the patients in group I, whose women with rheumatoid arthritis were in better life conditions than the ones in the control group. / Os pacientes com artrite reumatóide apresentam limitações físicas que restringem as atividades de vida diária, comprometendo a qualidade de vida. O tratamento fisioterapêutico tem como objetivo aliviar a dor, minimizar as deformidades, melhorar ou manter a mobilidade articular, impedir ou minimizar a incapacidade pela doença e educar os pacientes a se auto-gerenciar. O objetivo deste ensaio clínico, randomizado, controlado e simples cego é avaliar o efeito da cinesioterapia sobre a qualidade de vida de mulheres com artrite reumatóide. O estudo selecionou 40 mulheres com a doença, diagnosticadas após os 18 anos de idade, por um médico reumatologista; classificadas em grau funcional II e III, excluindo-se as pacientes com comorbidades. As mulheres foram distribuídas de forma aleatória, em dois grupos iguais e submetidas à anamnese específica. O grupo de trabalho (grupo I) foi avaliado quanto à sua qualidade de vida, através do questionário SF-36 e, posteriormente, submetido a um programa de cinesioterapia global, com nova avaliação sobre sua qualidade de vida, ao final do período (40 dias). O grupo controle (grupo II) não foi submetido à cinesioterapia, apenas avaliado quanto à qualidade de vida no início e no final do período de estudo. Foram analisadas as variáveis, através da anamnese: idade, tempo de doença, fator reumatóide, número de articulações, grau funcional, VHS, escolaridade e medicamentos, que poderiam interferir nos prognósticos e desenvolvimento da doença, comparando-as nos dois grupos, através do teste qui-quadrado e teste u-mann whitney, com á 0,05,para comprovação da homogeneidade dos grupos. Os dados do questionário S-F36 foram analisados e submetidos à validação estatística, utilizando-se o teste t-student, o teste u-man whitney e o teste wilcoxon para á 0,05. Para a comprovação da normalidade de cada uma das variáveis, utilizou-se o teste de aderência, kologorov smirnov. Confirma-se assim, através da análise da significância estatística, que o tratamento cinesioterapêutico influenciou positivamente a qualidade de vida dos pacientes do grupo I(grupo de trabalho). Concluímos então, que o grupo de mulheres com artrite reumatóide, submetidas à cinesioterapia, apresentou uma melhora significativa na qualidade de vida, em relação ao grupo controle.

INTRODUÇÃO: Artrite reumatoide é uma doença autoimune que causa inflamação nas membranas sinoviais de articulações chamadas diartroses. As articulações da orelha média podem estar sujeitas às mesmas lesões reumáticas que as outras articulações do corpo. Perdas auditivas neurossensoriais e condutivas foram observadas na literatura, assim como o envolvimento da artrite reumatoide na orelha média, mas os resultados não estão em concordância. A imitância acústica de banda larga pode fornecer maior sensibilidade a mudanças sutis nas articulações dos ossículos. OBJETIVO: avaliar o efeito da artrite reumatoide no sistema auditivo com enfoque na avaliação da orelha média. MÉTODOS: O delineamento desta pesquisa é estudo de casos comparando três diferentes grupos: dois grupos de indivíduos com artrite reumatoide e um grupo controle pareado por gênero e idade. Foram incluídos 39 participantes com idades entre 26 e 51 anos, de ambos os gêneros. O grupo estudo foi separado em dois: AR1, com 15 participantes (artrite reumatoide há dez anos ou mais); e AR2, com 9 participantes (artrite reumatoide há cinco anos ou menos). Estes grupos foram recrutados do ambulatório de reumatologia do Hospital das Clínicas da FMUSP e o grupo controle com 15 participantes, foi composto por voluntários, usuários do Centro de Docência e Pesquisa da FMUSP. Os procedimentos utilizados foram: Imitanciometria com sonda de 226 Hz, audiometria tonal liminar, audiometria de altas frequências e imitância acústica de banda larga, cujos dados foram extraídos como bandas de 1/3 de oitava para reflectância de energia em um documento de extensão Excel. Para análise dos dados, utilizaram-se estatística descritiva, análise de variância, teste quiquadrado e Kruskal-Wallis. RESULTADOS: As médias de idade para AR1, AR2 e controle foram de 41,1, 38,6 e 39,9 anos, respectivamente, e não houve diferença significante entre grupos. As medidas de imitanciometria 226 Hz (timpanometria e reflexos acústicos ipsilaterais) e reflectância de energia não demonstraram diferença significante entre os grupos. Foram encontradas diferenças na comparação entre os grupos AR1 e AR2 e grupo controle para os testes audiometria tonal liminar, e AR1 com o grupo controle para audiometria de altas frequências e reflexos acústicos contralaterais. Não foi observada diferença entre os resultados da orelha direita e da esquerda. CONCLUSÕES: Os grupos de artrite reumatoide apresentaram o mesmo padrão de resposta para as avaliações de orelha média do grupo controle, levantando a possibilidade de apresentarem um mesmo comportamento de sistema ou de que as ferramentas utilizadas para avaliação não são sensíveis para detectar as mudanças sutis. Foi possível observar mudança nos limiares audiométricos e de altas frequências dos grupos com artrite reumatoide em comparação com o grupo controle, mostrando a importância de monitorização auditiva nessa população / BACKGROUND: Rheumatoid arthritis (RA) is an autoimmune disease that causes inflammation of synovial membranes of the diarthrodial joints. Middle ear joints may be subject to the same rheumatic lesions as other joints in the body. Sensorineural and conductive hearing loss have been reported, as well as middle ear involvement, but the results are not in agreement. Wideband acoustic immittance (WAI) may provide better sensitivity to subtle changes in the ossicular joint. PURPOSE: To evaluate the effect of RA in the auditory system focusing on the middle ear assessment with WAI. METHODS: This was a cross-sectional study comparing audiological behavior of 3 different groups: two groups of individuals with rheumatoid arthritis and a normal control (NC) group matched 1:1 based on age and gender. Thirty-nine participants, raging age from 26-51 years old, male and female. The study groups were pooled into two groups: RA1 with 15 participants (patients who had had RA for more than ten years) and RA2 with nine participants (those who had had RA for less than five years). The study groups were recruited from rheumatology clinic of Hospital das Clinicas (FMUSP) and were compared with 15 normal control, which consisted in volunteer students or employees from Centro de Docencia e Pesquisa (FMUSP). Standard 226 Hz probe tone tympanometry, pure-tone audiometry, extended high-frequency audiometry and WAI were performed in all subjects. The results from WAI were extracted as 1/3 octave bands for energy reflectance as an Excel file. Descriptive statistics, chi-square test, mixed model ANOVA and Kruskal-Wallis test were used to investigate the differences in all performed tests across the three groups. RESULTS: Mean ages for RA1, RA2 and NC were 41.1, 38.6 and 39.9 years old respectively and the difference between groups was not statistically significant. Comparison of standard immittance measures (such as 226 Hz probe tone tympanometry and ipsilateral acoustic reflex) and 1/3 octave band energy reflectance did not reveal significant difference between groups. This study found difference in standard audiometry thresholds comparing RA1 and RA2 to NC group, extended high-frequency audiometry and contralateral acoustic reflex comparing RA1 group to NC group. There was no significant difference between right and left ears. CONCLUSIONS: RA groups showed the same middle ear response pattern than the NC group, there was either no significant difference between the middle ears of RA patients and healthy individuals, or WAI is not appropriate for differentiating these two groups. Pure-tone audiometry and extended high-frequency audiometry showed different behaviors between the three groups. The actual incidence of hearing loss in RA remains to be defined. The results showed the importance of monitoring potential audiological manifestations in patients with RA