Η λεπτίνη είναι μια ορμόνη 16 kD που κωδικοποιείται απότογονίδιο obκαι παράγεται από τα λιποκύτταρα ρυθμίζοντας το ενεργειακό ισοζύγιο. Τα επίπεδα λεπτίνης στο πλάσμα είναι ανάλογα με το δείκτη σωματικής μάζας (BMI), ενώ η έκφρασή της εξαρτάται από τη νηστεία και τη σίτιση, την ινσουλίνη, τα γλυκοκορτικοειδή, καθώς και από προφλεγμονώδεις κυτταροκίνες, κύριως τον TNF-α και την IL-1. Το μόριο της λεπτίνης παρουσιάζει ομοιότητες με τη μακριά έλικα των κυτταροκινών και δρά μέσω του υποδοχέα της (OB-R), ο οποίος ανήκει στην υπεροικογένεια των υποδοχέων των κυτταροκινών και εμφανίζεται σε ποικιλία ισομορφών ενώ εκφράζεται σε διάφορους ιστούς και κύτταρα του νευροενδοκρινικού, αναπαραγωγικού, αιματοποιητικού και ανοσοποιητικού συστήματος. Η λεπτίνη εμπλεκεται και σε αυτοάνοσες καταστάσεις με το να προάγει τη διατήρηση παθογόνων Th1 κυτταρικών υποπληθυσμών. Στην παρούσα μελέτη προκειμένου να διερευνήσουμε το ρόλο της λεπτίνης σε αυτοάνοσες καταστάσεις μετρήσαμε τα επίπεδα αυτής και του υποδοχέα της σε ασθενείς με ρευματοειδή αρθρίτιδα, μια χρόνια συστεμική αυτοάνοση νόσο, για να δούμε εάν αυτά σχετίζονται με το στάδιο της νόσου ή τη θεραπεία. Ακόμη μελετήθηκε η εμπλοκή της λεπτίνης στην έκφραση προ- και αντιφλεγμονωδών κυτταροκινών στον ορό ασθενών και μαρτύρων. Τα αποτελέσματα δείχνουν πως τα επίπεδα λεπτίνης είναι υψηλά στους ασθενέις με ΡΑ. Επιπλέον τα επίπεδα λεπτίνης δεν βρέθηκε να σχετίζονται με το στάδιο της νόσου ή τη χορηγούμενη θεραπεία. Παρόλα αυτά τα αυξημένα επίπεδα λεπτίνης σε ασθενείς με ρευματοειδή αρθρίτιδα καταδεικνύουν ενδεχομένως έναν παθογενετικό ρόλο της λεπτίνης. / Leptin is a 16 kD peptide hormone, encoded by the ob gene and synthesized mainly by adipocytes to regulate the energy balance. In humans, leptin plasma levels are strongly correlated with body mass index (BMI) and the expression of leptin is regulated by fasting and feeding, insulin, glucocorticoids and pro-inflammatory cytokines, mainly TNFa and IL-1. Leptin is structurally similar to long-chain helical cytokines and it signals through its receptor, OB-R, which is a member of the cytokine receptor superfamily. OB-R comes in a variety of protein isoforms, and is expressed in several tissues and cells of the neuroendocrine system as well as the reproductive, hematopoietic and immune systems. Leptin has also been implicated in the pathogenesis of autoimmunity. It has also been suggested that leptin may promote the expansion and maintenance of pathogenic Th1-cell populations in autoimmune diseases. In this study to investigate the role of leptin in human autoimmunity, we measured leptin and OB-Rs levels inthe sera of patients suffering from rheumatoid arthritis (RA), a common chronicsystemic inflammatory disease, and tested for a possible correlation with disease activity and type of treatment. In addition, we studied whether leptin has an effect on the expression patterns of pro- and anti-inflammatory cytokine genes in PBMC isolated from RA patients and controls.Our results showed significantly elevated serum leptin levels in the rheumatoid population compared to the healthy controls.In addition, there was an absence of correlation between serum leptin levels and disease activity, as well as the nature and quantity of the medications administered to the patients. The absence of correlation between serum leptin levels and disease activity, coupled with the significantly and stably elevated levels of this hormone in the rheumatoid sera compared to the controls, are probably indicative of an insiduous pathogenetic role of leptin in rheumatoid arthritis.

Rheumatoid arthritis (RA) is a debilitating chronic inflammatory disease causing bone and cartilage degradation. Macrophages are known to play a role in RA pathology by producing pro-inflammatory cytokines and chemokines, which activates immune cells, drives inflammation and facilitates the degradation of bone and cartilage. Alterations in epigenetic mechanisms, processes that regulate gene expression, have been implicated in the regulation of pro-inflammatory cytokines in RA. Therefore, the aim of this thesis was to determine specific epigenetic variation between RA patient blood and synovial fluid (SF)-derived macrophages (SF MLS). Granulocyte and macrophages colony stimulating factor (GM-CSF) was used to differentiate healthy donor and RA patient blood monocytes into macrophages. Lipopolysaccharide (LPS) was used to stimulate blood and SF-derived macrophages to initiate inflammatory cytokine production. A library of small molecule inhibitors was used to identify key epigenetic regulators of pro-inflammatory cytokine production. Bromodomain and extra-terminal (BET) protein inhibitors (JQ1, I-BET151, PFI-1) were the only class of inhibitor to show consistent down regulation of pro-inflammatory cytokines in both healthy and RA patient-derived macrophages. However, only JQ1 was shown to reduce TNFα production significantly in SF MLS. Transcriptional profiling of RA patient SF MLS indicated a preference for a pro-inflammatory phenotype, and a resistance to steroids (a trait found in 30% of RA patients); SF MLS production of chemokines and cytokines were not downregulated by glucocorticoids in comparison to corresponding blood-derived macrophages. However, JQ1 treatment successfully suppressed these genes. In addition, silencing of BRD4 in blood-derived macrophages from healthy donors reduced pro-inflammatory cytokine production. Chromatin immunoprecipitation studies showed BRD4 was localised to pro-inflammatory promoter regions upon LPS stimulation and displaced in the presence of JQ1. These studies identified BET proteins BRD2, 3 and 4, as essential epigenetic regulators of pro-inflammatory cytokine and chemokine production in both healthy donors and RA patient macrophages. Furthermore, the observation that BET inhibitors can regulate genes that are steroid resistant in RA patient SF MLS, highlights their therapeutic potential in RA.

Orientador: Alexandrina Sartori / Banca: Liana Maria Cardoso Verinaud / Banca: Vânia Luiza Deperon Bonato / Banca: Angela Maria Victoriano de Campos Soares / Banca: Paula Schmidt Azevedo Gaiolla / Resumo: A artrite reumatoide (AR) é uma doença autoimune que compromete as articulações. A maioria das terapias utilizadas para o seu tratamento é baseada na inibição global da resposta imune, podendo aumentar a susceptibilidade a agentes infecciosos. O objetivo geral deste projeto foi definir estratégias tolerogênicas específicas para profilaxia ou terapia da AR. Para isso, em uma primeira etapa, estabelecemos um modelo de artrite induzida por proteoglicano (PG) bovino. Camundongos BALB/c fêmeas retired breeders imunizados com PG bovino associado ao adjuvante brometo de dimetil dioctadecil amônio apresentaram os sinais clínicos característicos da artrite, como eritema e edema decorrentes da inflamação articular de uma ou mais patas. A análise histopatológica mostrou a presença de hiperplasia sinovial, infiltrado inflamatório (formação de pannus), destruição da cartilagem e erosão óssea. A incidência da doença foi de 100% e os animais artríticos produziram níveis significativos de citocinas pró e anti-inflamatórias e anticorpos IgG1 e IgG2a anti-PG. Em uma segunda etapa, testamos o potencial profilático do PG. A inoculação de três doses de 50 μg de PG determinou um efeito profilático caracterizado pela diminuição significativa da incidência da artrite e do escore clínico dos animais. A diminuição da produção de IFN-g e IL-17, bem como o aumento da produção de IL-4 e IL-10 por células esplênicas estimuladas com PG, podem estar contribuindo para o efeito profilático observado neste grupo. Em uma terceira etapa, avaliamos o potencial terapêutico da associação da vitamina D ativa (VitD3) com o PG. A associação VitD3+PG determinou um efeito terapêutico na artrite experimental caracterizado por diminuição significativa do escore clínico. Este feito foi confirmado pela análise histopatológica que revelou que a maioria das patas do grupo tratado apresentou estrutura articular bem preservada, ... / Abstract: Rheumatoid arthritis (RA) is an autoimmune disease that affects the joints. Most of the therapies used for RA treatment are based on general suppression of immune response, which may increase the susceptibility to infectious agents. The main objective of this work was to establish specific tolerogenic strategies for prophylaxis or therapy of RA. For this purpose, we first established a model of arthritis induced by bovine proteoglycan (PG). Female BALB/c retired breeder mice immunized with bovine PG associated with dimethyl-dioctadecyl ammonium bromide adjuvant developed a typical arthritis characterized by erythema and edema resulting from joint inflammation of one or more paws. Histopathological analysis showed the presence of synovial membrane hyperplasia, inflammatory infiltrates (pannus formation), cartilage destruction and bone erosion. Disease incidence was 100% and the arthritic mice produced significant levels of pro and anti-inflammatory cytokines and IgG1 and IgG2a anti-PG antibodies. Further, we tested the prophylactic potential of PG. Three doses of 50 μg of PG determined a prophylactic effect characterized by a significant decrease in both, arthritis incidence and clinical scores. The decrease in IFN-g and IL-17, as well as the increase in IL-5 and IL-10 production by spleen cells stimulated with PG may be contributing to the prophylactic effect observed in this group. Lastly, we evaluated the therapeutic potential of the combination of active vitamin D (VitD3) with PG. The VitD3+PG association determined a therapeutic effect in experimental arthritis. There was a significant decrease in the clinical scores after VitD3+PG treatment that was confirmed by the histopathological analysis. Most mice paws from the treated group presented well preserved joint structures that were similar to the ones present in healthy animals. Both pro and anti-inflammatory cytokines were decreased after this treatment. No differences were ... / Doutor

Introdução: A atrite reumatoide (AR) é uma doença Inflamatória crônica de etiologia desconhecida que afeta principalmente as articulações. A evolução da doença está associada com a incapacidade funcional, aumentando o risco de doenças cardiovasculares (DCV) e disfunção endotelial e rigidez arterial. Objetivo: Avaliar os efeitos de uma única sessão de exercício aeróbico de alta intensidade na função endotelial mediada pelo fluxo (DMF), avaliar a dor no pré exercício e após uma semana de intervenção através da escala visual analógica (EVA) e rigidez arterial em pacientes 26 com AR. Métodos: Estudo quase experimento, com 22 pacientes portadores de AR leve a moderada. Foram realizados teste ergoespirométrico, ecografia braquial para determinar a dilatação mediada pelo fluxo (DMF) e a avaliação da rigidez arterial por determinação da velocidade de onda de pulso (VOP), pré, pós e uma hora após a aplicação de um protocolo de treinamento intervalado de alta intensidade (TIAI). Resultados: A média de idade dos participantes é de 59,2 + 7,6 anos e há predominância do sexo feminino (91%). Apresentaram DAS28 de 4,1+ 1,0 (atividade moderada), e HAQ de 1+ 0,6 pontos (deficiência moderada). O VO2 Máximo encontrado foi de 21,19 + 3,89 ml/Kg/min. Os valores de DMF nos três momentos foram: basal com hiperemia reativa (10,59+0,47) e com nitroglicerina spray sublingual (12,66+0,89), no pós imediato (10,69+ 0,39) e com nitroglicerina (12,93+0,58), e 1 hora após (10,93+0,29) e com o medicamento (13,20+0,46), em relação a escala analógica visual de dor (EVA) observamos no basal uma dor de (3,45+0,80) e pós uma semana de intervenção (2,50+0,51). Conclusão: Concluímos que o TIAI com portadores de AR não foi significativo em relação às porcentagens de DMF, mas quando observamos outras medidas como a VOP, Pressão Arterial, Pressão de Pulso e o Índice de Aumentação, e os pacientes não apresentaram dor após uma semana de intervenção, sendo assim o exercício parece ser eficiente, sugerindo que pode ser uma estratégia útil para a prevenção de DCV em pacientes com AR. / Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory disease of unknown etiology that mainly affects the joints. The evolution of the disease is associated with functional disability, increasing the risk of cardiovascular diseases (CVD) and endothelial dysfunction and arterial stiffness. Objective: To evaluate the effects of a single high-intensity aerobic exercise session on flow-mediated endothelial function (DMF), evaluate pain in pre-exercise and after one week of intervention using visual analogue scale (VAS) and arterial stiffness in patients with AR. Methods: Almost experimental study with 22 patients with mild to moderate RA. An ergospirometric test, brachial ultrasound was performed to determine the flow-mediated dilatation (FMD) and the evaluation of arterial 53 stiffness by determination of the pulse wave velocity (VOP), pre, post and one hour after the application of an interval training protocol high intensity (TIAI). Resultados: A média de idade dos participantes é de 59.2 + 7.6 anos e há predominância do sexo feminino (91%). Apresentaram DAS28 de 4.1+ 1.0 (atividade moderada), e HAQ de 1+ 0.6 pontos (deficiência moderada). O VO2 Máximo encontrado foi de 21.19 + 3.89 ml/Kg/min. Os valores de DMF nos três momentos foram: basal com hiperemia reativa (10.59+0.47) e com nitroglicerina spray sublingual (12.66+0.89), no pós imediato (10.69+ 0.39) e com nitroglicerina (12.93+0.58), e 1 hora após (10.93+0.29) e com o medicamento (13.20+0.46), em relação a escala analógica visual de dor (EVA) observamos no basal uma dor de (3.45+0.80) e pós uma semana de intervenção (2.50+0.51). Conclusion: We conclude that the TIAI with RA patients was not significant in relation to DMF percentages, but when we observed other measures such as OPV, Blood Pressure, Pulse Pressure and Increasing Index, and patients did not present pain after one week the exercise appears to be efficient, suggesting that it may be a useful strategy for the prevention of CVD in patients with RA.

Leflunomide is widely prescribed for Rheumatoid Arthritis (RA) patients in China. However, a number of RA patients still demonstrated progressive bone erosion (PBE+) after receiving Leflunomide in our clinical data. Moreover, the PBE+ is predicted by high baseline serum CRP level (CRPBH). Further, the changes of serum bone resorption marker (Tartrate-resistant acid phosphatase 5b, TRAP5b) strongly correlated with those of CRP in PBE+ RA patients during Leflunomide treatment. Those were consistently observed in collagen-induced-arthritis (CIA) rats. To precisely address the issue, we screened a series of marketed drugs combined with Leflunomide to inhibit CRP production and CRP-related osteoclastic signaling pathway using bioinformatics analysis. Ligustrazine was postulated as an optimal candidate drug. In vitro studies demonstrated that the combination of Ligustrazine and Leflunomide not only suppressed hepatic CRP production, but also suppressed CRP-related osteoclastic signaling and osteoclast activities. In vivo studies showed that the combination attenuated bone erosion in CIA rats. Further, the randomized parallel controlled clinical trial in 120 CRPBH RA patients showed that the combination therapy reduced serum CRP levels and attenuated bone erosion in those patients (ChiCTR-TRC-10001014). Together, this work presents a precision combination therapy for PBE+ in CRPBH RA patients.

Base Teórica: A artrite reumatoide (AR) é uma doença crônica e inflamatória que além de sintomas articulares pode levar à perda de massa muscular com peso estável ou aumentado, condição denominada caquexia reumatoide (CR). A CR está associada com pior prognóstico, mas ainda é negligenciada na prática clínica. Objetivo: Avaliar a prevalência de CR em um hospital público terciário de Porto Alegre e determinar sua correlação com características da AR, com níveis de atividade física e com as medicações em uso. Métodos: Estudo transversal com 91 pacientes com AR que foram submetidos à densitometria corporal total (DEXA) para medida total e regional de índice de massa gorda (IMG; Kg/m2), índice de massa magra (IMM; Kg/m2), conteúdo mineral ósseo (CMO) e índice de massa livre de gordura (IMLG; Kg/m2) para avaliar a prevalência de CR pelas duas definições mais recentemene utilizadas na literatura: IMLG < percentil 10 com IMG > percentil 25 e IMLG < percentil 25 com IMG > percentil 50. Foram exploradas as medidas de associação dos parâmetros de composição corporal com características da AR – idade, duração da doença, atividade de doença (através do DAS 28), capacidade funcional (através do HAQ), atividade inflamatória (através da proteína C reativa – PCR – e velocidade de hemossedimentação – VHS), nível de atividade física (através do questionário IPAQ) e medicações em uso. Resultados: A idade média dos participantes foi 56,8 ± 7,3, a duração de doença foi 9 anos (3-18), o DAS 28 3,65 ± 1,32, o HAQ 1,12 (0,25 – 1,87) e o tempo de uso entre os que usaram biológico foi de 25 meses (17,8 – 52,5). A CR foi evidenciada em 17,6% dos pacientes com AR de acordo com a definição mais rigorosa e em 33% de acordo com a classificação mais abrangente. O IMLG teve correlação negativa com idade (r= -0,219; p=0,037) e duração da doença (rs= -0,214; p=0,042). O IMG teve correlação positiva com PCR (rs=0,229; p=0,029), VHS (rs=0,235; p=0,025), DAS 28 (rs=0,273; p=0,009) e HAQ (rs=0,297; p=0,004). Na comparação de pacientes com e sem CR, de acordo com a definição mais rigorosa, dos 26 pacientes usando biológico apenas 1 tinha CR (3,8%), enquanto dos que não usavam, 15 (23%) tinham CR (p=0,033). Conclusão: A prevalência de CR foi considerável e, portanto, merece estudos adicionais. A composição corporal neste estudo, especialmente o IMLG, teve associação inversa com idade e tempo de diagnóstico. Além disso, pacientes em uso de biológico tiveram diferença significativa na prevalência de CR, sugerindo papel protetor do uso de biológico na CR. / Background: Rheumatoid arthritis (RA) is a chronic and inflammatory disease that besides articular symptoms leads to loss of muscle mass in presence of stable or increased fat mass (FM), condition defined as rheumatoid cachexia (RC). RC is associated with a worse prognosis, but it is still overlooked in clinical practice. Objective: To evaluate the prevalence of rheumatoid cachexia (RC) in patients with rheumatoid arthritis (RA) and determine its correlation with the features of RA, the level of physical activity and with the current therapy. Methods: Ninety one RA patients in a cross-sectional study underwent total body dual-energy x-ray absorptiometry (DXA) for measurement of total and regional fat mass index (FMI; Kg/m2), lean mass index (LMI; Kg/m2), bone mineral content (BMC; Kg/m2) and fat free mass index (FFMI; Kg/m2) to assess the prevalence of RC. The associations of measures of body composition with RA features - age, diagnosis time, Health Assessment Questionnaire (HAQ), Disease Activity Score in 28 joints (DAS 28), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) -, level of physical activity (measured by International Physical Activity Questionnaire – IPAQ) and current therapy were explored. Results: Mean age was 56,8 ± 7,3 , disease duration 9 years (3 – 18), DAS28 3,65 ± 1,32, HAQ 1,12 (0,25 – 1,87) and use duration of biological agents was 25 months (17,8 – 52,5). Seventeen per cent of the patients had FFMI below the 10th percentile and FMI above the 25th percentile of a reference population and 33% of the patients had FFMI below the 25th percentile and FMI above the 50th percentile, condition known as RC, according to the more recently used definitions. FFMI correlated negatively only with age (r=-0,219; p=0,037) and disease duration (rs=-0,214; p=0,042). FMI correlated positively with CRP (rs=0,229; p=0,029), ESR (rs=0,235; p=0,025), DAS 28 (rs=0,273; p=0,009) and HAQ (rs=0,297; p=0,004). Of the 26 patients using biological therapy, 25 were non cachetic (p=0,033) according to the stricter definition of RC. In another words, 3,8% (n=1) and 23% (n=15) of the patients receiving and not receiving biological agents had RC, respectively (p=0,033). Conclusion: The prevalence of RC was considerable and deserves additional research. Body composition, in this study, particularly FFMI is inversely associated with age and disease duration. Besides that, patients under biological therapy had lower prevalence of RC, suggesting a protective effect of biological agents.

Abstarct Analysis of the Therapy in Patients with Juvenile Idiopathic Arthritis Author: Martina Procházková Tutor: PharmDr. Josef Malý, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction and aims: Methotrexate (MTX) is an effective and safe drug used for the treatment of juvenile idiopathic arthritis (JIA) and is well-known like a golden standart in the treatment of this serious illness. The aim of this study was analysis of therapy in patients with JIA focusing on MTX and faktors affecting its intolerance. Methods: The study was undertaken from January 2017 to February 2018 at the Department of Paediatrics and Adolescent Medicine, 1st Faculty of Medicine, Charles University in Prague. Patients younger than 18 years old, who have become ill with JIA for the first time or repeatedly between years 2015-2017 and were treated by MTX were included in this study. The prevalence of MTX intolerance was measured by "Methotrexate Intolerance Severity Score" questionaire every 3 months during regular rheumatological examinations. Simultaneously, medical records were reviewed. Data analysis was performed by means of descriptive statistics, correlation dependence and statistical signifikance of dependence was assessed with statistical two-choice...

Rheumatoid arthritis (RA), the most common autoimmune disease, affects billions of people worldwide. Conventional therapeutics do not provide satisfactory efficacy and even cause severe adverse reactions. Researchers are seeking new approaches for RA management. Toll-like receptor 4 (TLR4) signalling plays a pivotal role in the pathogenesis of RA, and has been proposed as a potential therapeutic target for RA. Chinese medicines are believed to be alternative options for conventional RA therapeutics. A herbal formula RL, consisting of Rosae Multiflorae Fructus and Lonicerae Japonicae Flos, has traditionally been used in treating various inflammatory disorders including RA. In this study we assessed the anti-arthritic efficacy of RL in animals, and investigated the involvement of TLR4 signalling in RL's effects in vivo and in vitro. In vivo anti-arthritic efficacy of RL was evaluated using CIA (collagen-induced arthritis) rats, a model that is well established for studying human RA. Articular disease manifestations were investigated grossly, radiographically, and histologically. Isolated splenocytes were used to determine the effects of RL on immune responses. Molecular events in the TLR4 pathways upon RL treatment were examined in sera and joint tissues of CIA rats as well as in cultured lipopolysaccharide (LPS)-stimulated murine RAW264.7 and human THP-1 cells.

Rheumatoid Arthritis (RA) is a chronic auto-immune disease that causes in ammation in the joints. Left uncontrolled, this prolonged in ammation can lead to pain and structural damage, resulting in erosions to the bones and total breakdown of the surrounding cartilage. Structural joint damage, measured by plain radiographs, is an important outcome measure of RA. It provides an objective marker of disease activity to assess any improvements or failures of treatments in controlling for the disease. Increased long-term joint damage has been linked with increased functional disability and decreased quality of life for RA patients. While a range of studies have looked at radiographic outcomes from observational data, they tend to be restricted to historical cohorts, with little long-term data on how radiographic progression may have changed in line with changes in clinical management. Additionally, these studies have not used the appropriate statistical methods to account for non-normal data distributions and within-patient variation over time. As a result, the main aim of this thesis is to investigate the long-term progression of structural joint damage in patients with early RA. The speci c objectives were to; (1) investigate the current evidence base to identify common methods in measuring and analysing radiographic outcomes, (2) assess what statistical methods are most appropriate in modelling long-term radiographic data, (3) use these models to understand the natural progression of radiographic damage using data from two UK inception cohorts, and nally, (4) expand these models to investigate the long-term relationship of radiographic damage with two important clinical outcomes; disease activity and functional disability. The analysis is based on longitudinal data from two UK prospective, multi-centre, early RA observational cohorts. These cohorts represent two distinct eras in the management and treatment of RA, making them invaluable for investigating how key RA outcomes have progressed in clinical practice over time. Using multi-level count models, precise rates of radiographic progression for both cohorts are presented. The models look at how seropositive RA and increased disease activity are related to increased radiographic progression, and what impact this has on functional disability. The results show that rates of radiological damage have declined dramatically in recent years. Possible attributable factors to these declines include both milder disease and more e ective treatment strategies. Analysis of the earlier cohort (1986-2001) shows how seropositive RA and increased disease activity lead to clinically meaningful increases in radiological damage. Conversely, their impact on patients in the more recent cohort (2002-2011) suggest that their e ect on radiographic progression is reduced, where increases in radiological damage were not larger than clinically meaningful thresholds. This has large implications on the debate around the use of biologic therapies in patients with less severe RA. However more data is sorely needed, particularly long-term radiographic data from those patients on biologics treatments, before any de nitive conclusions can be made. The possible impact of these declines on functional disability appears to be relatively small. The analysis shows that radiographic damage is more strongly associated with functional disability in later disease, but there is little evidence to indicate that declines in radiographic damage has lead to large improvements in long-term functional disability. These ndings are explored within the framework of a dual-pathway model, which suggests that functional disability is caused by two distinct mechanisms, either structural joint damage, or through increased pain. Research so far has predominantly focused on pharmacological treatments in reducing in ammation. More research is needed to explore the role of psychosocial factors and pain perception in order to create a more holistic treatment programme for RA patients.

Fundação Carlos Chagas Filho de Amparo a Pesquisa do Estado do Rio de Janeiro / O gênero Pterodon pertence à família das Fabaceae e inclui quatro espécies nativas do Brasil: P. emarginatus Vog., P. apparicioi Pedersoli, P. abruptus Benth. e a espécie objeto deste estudo P. polygalaeflorus Benth.. Seus frutos são utilizados pela medicina popular devido às propriedades antirreumática, analgésica, anti-inflamatória, dentre outros. O objetivo deste trabalho foi avaliar a espécie Pterodon polygalaeflorus quanto ao seu potencial anti-inflamatório, antiartrítico e toxicológico, através da análise de seus efeitos em modelos in vitro e in vivo. Os extratos EEPpg, EHPpg e EDPpg reduziram (p<0,01) a produção in vitro de NO, por macrófagos ativados por LPS, com baixa citotoxicidade e diminuíram a celularidade (p<0,05) no exsudato inflamatório no modelo de inflamação in vivo conhecido como air pouch. O extrato mais ativo (EHPpg) foi selecionado e submetido a fracionamento em coluna de sílica gel 60 gerando quatro frações. Todas as frações (Fr I-Fr IV) reduziram: a produção de NO (p<0,001) por macrófagos ativados, com baixa ou nenhuma citotoxicidade; a migração de macrófagos in vitro (p<0,01, ensaio de wound healing) e in vivo (p<0,05, peritonite induzida por tioglicolato); e a proliferação de esplenócitos estimulados com Con A (p<0,001). As frações III e IV, mais ativas nos ensaios anteriores, mostraram ação antiartrítica (com 0,02 mg/kg), utilizando o modelo in vivo de artrite induzida por adjuvante completo de Freund (AIA), demonstrada por redução: do índice de edema de pata em 23,7% (Fr III) e 43,95% (Fr IV); das lesões histopatológicas na região tíbio-tarsal típicas de articulações com AIA (p< 0,05); do peso e celularidade do linfonodo e do baço, mas não da celularidade da medula óssea; das subpopulações de linfócitos (CD4+, CD8+ e CD19+) nos linfonodos inguinais, porém com significativo aumento das subpopulações ativadas CD4+CD69+, redução da CD8+CD69+ e aumento de CD19+CD69+ (apenas na Fr III); e redução da população de macrófagos no baço (p<0,001). As frações III e IV mostraram ação imunossupressora em nível celular e molecular, reduzindo (p<0,001) os níveis do mRNA da iNOS, assim como as citocinas IL-1&#946;, TNF-&#945; e IL-10, em nível de mRNA e proteína, em cultura de macrófagos. A expressão do receptor CD14, em macrófagos estimulados por LPS (31,74%), foi inibida apenas pela Fr III. A osteoclastogênese foi inibida pelas frações III e IV, sugerindo uma ação antiartrítica das frações em nível de diferenciação celular para osteoclastos (inibição). Este efeito pode resultar da inibição da expressão do fator de transcrição NFATc1, no caso da Fr III. Por fim, as frações Fr III e Fr IV não apresentaram toxicidade subaguda, potencial mutagênico (teste de Ames) ou genotóxico (teste do micronúcleo). A ausência de toxicidade in vivo das frações ficou demonstrada pela ausência de alteração no peso corporal e de órgãos, nas concentrações séricas de creatinina, ácido úrico, triglicerídeos, colesterol, ALT e ALP, ou de CYP1A1 e GSTs no fígado. Análises fitoquímicas (GC-MS e TLC) mostraram uma grande variedade de terpenos nas frações III e IV, sendo majoritários os furano-diterpenos derivados do vouacapano. O diterpeno isolado, Ppg-01, presente nas frações III (5,12%) e IV (18,47%), reduziu a produção in vitro de NO e o edema de pata induzido por carragenina (p<0,001). Em conjunto, os dados sugerem que o Ppg-01 esteja contribuindo para as ações anti-inflamatórias e imunomoduladoras das frações III e IV, e que estas propriedades estejam associadas aos efeitos antiartríticos observados.