Periodontal condition in patients with rheumatoid arthritis

The purpose of this clinical study was to investigate if periodontal disease and rheumatoid arthritis (RA) are associated. The study included 39 RA patients (test group) and 22 age- and gender-matched healthy individuals (control group). Questionnaires on general and oral health were applied and a complete periodontal exam, including visible plaque, marginal bleeding, attachment loss (AL) and number of teeth present, was also performed by a single calibrated examiner. Diabetes mellitus patients and smokers were excluded. RA patients had fewer teeth, higher prevalence of sites presenting dental plaque and a higher frequency of sites with advanced attachment loss. Although the prevalence of dental plaque was higher in the test group (Chi-square test, p = 0.0006), the percentage of sites showing gingival bleeding was not different (Fisher's exact test, p > 0.05). Based on our results, we suggest that there is an association between periodontal disease and RA.

Comparação entre o Disease Activity Score-28 e o Juvenile Arthritis Disease Activity Score na artrite idiopática juvenil

Introduction: the assessment of the activity of rheumatoid arthritis and juvenile idiopathic arthritis is made by means of different tools, respectively DAS-28 and JADAS.Objective: To compare DAS-28 and JADAS with scores of 71, 27 and 10 joint counts in juvenile idiopathic arthritis.Method: A secondary analysis of a phase III placebo-controlled trial, testing safety and efficacy of abatacept was conducted in 8 patients with 178 assessment visits. Joint count scores for active and limited joints, physician's and parents'global assessment by 0-10 cm Visual Analog Scale, and erythrocyte sedimentation rate normalized to 0-10 scale, in all visits. The comparison among the activity indices in different observations was made through Anova or adjusted gamma model. The paired observations between DAS-28 and JADAS 71, 27 and 10, respectively, were analyzed by linear regression.Results: There were significant differences among individual measures, except for ESR, in the first four months of biological treatment, when five of the eight patients reached ACR-Pedi 30, with improvement. The indices of DAS-28, JADAS 71, 27 and 10 also showed significant difference during follow-up. Linear regression adjusted model between DAS-28 and JADAS resulted in mathematical formulas for conversion: [DAS-28 = 0.0709 (JADAS 71) + 1.267] (R-2 = 0.49); [DAS-28 = 0.084 (JADAS 27) + 1.7404] (R-2 = 0.47) and [DAS-28 = 0.1129 (JADAS-10) + 1.5748] (R-2 = 0.50).Conclusion: The conversion of scores of DAS-28 and JADAS 71, 27 and 10 for this mathematical model would allow equivalent application of both in adolescents with arthritis. (C) 2014 Elsevier Editora Ltda. All rights reserved.

Proposta de questionário para caracterização da prevalência de sintomas digestivos nas doenças difusas do tecido conjuntivo

RACIONAL: As doenças difusas do tecido conjuntivo afetam vários sistemas orgânicos, inclusive o digestório. Neste, as lesões variam em intensidade e freqüência na dependência da doença envolvida. A descrição das diferentes manifestações digestivas tem sido pouco freqüente, pouco detalhada e, não raro, baseada em experiências individuais e levantamentos retrospectivos. Tais formas de registro de dados produzem resultados muitas vezes conflitantes entre as diferentes casuísticas. OBJETIVO: Estabelecer de forma mais consistente, por intermédio de entrevista e questionário predefinido de sintomas, o conjunto e freqüência dos sintomas digestivos observados na esclerose sistêmica progressiva, artrite reumatóide, polimiosite/dermatomiosite, doença mista do tecido conjuntivo e lúpus eritematoso sistêmico. PACIENTES E MÉTODO: Estudaram-se 99 pacientes, 90% mulheres, com idade média de 45 anos. do total, 35 tinham artrite reumatóide, 26 esclerose sistêmica progressiva, 21 lúpus eritematoso sistêmico, 12 dermatomiosite/polimiosite e 5 doença mista do tecido conjuntivo. Todos foram submetidos, por investigador treinado, a entrevista e preenchimento de um questionário de sintomas digestivos, composto de 17 itens, previamente definidos. RESULTADOS: O estudo revelou elevada prevalência de sintomas gastrointestinais nas cinco doenças investigadas, muitas vezes afetando mais de 50% dos casos. Chamou a atenção a presença significativa de sintomas negligenciados pela literatura como a incontinência fecal. Discordante de trabalhos anteriores, os pacientes desta série com artrite reumatóide apresentaram variadas queixas digestivas, surpreendendo o achado de disfagia em 1/3 deles. CONCLUSÕES: As doenças difusas do tecido conjuntivo são causas de freqüentes e numerosos sintomas digestivos. O uso de questionários predefinidos mostrou-se instrumento válido na identificação de substancial número de sintomas, alguns deles ainda não referidos pela literatura. Por fim, foi constatada escassez de trabalhos passados e atuais relativos às manifestações gastrointestinais das doenças difusas do tecido conjuntivo, o que prejudicou análises comparativas mais amplas.

Cirurgia ortognática associada á cirurgia das ATMs acometidas por artrite reumatóide ou osteocondroma

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Is rheumatoid arthritis a risk factor for oral bisphosphonate-induced osteonecrosis of the jaws?

Bisphosphonate-related osteonecrosis of the jaws is a relevant side-effect of these drugs that has been generating a great concern through increasing reports, worldwide, of this bone necrosis. Among several BRONJ hypothetical co-factors that could play a role in BRONJ pathogenesis, rheumatoid arthritis (RA) has been included as a relevant risk factor for BRONJ; however, until now the relationship between these diseases has not been fully explained. Thus, the purpose of this paper is to establish hypothetical factors that could link these two diseases, considering mainly inflammatory components and the organism effects of medicines used to treat RA, particularly steroids and methotrexate (MTX). (C) 2011 Elsevier Ltd. All rights reserved.

Oral bisphosphonate-related osteonecrosis of the jaws in rheumatoid arthritis patients: a critical discussion and two case reports

Background: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a clinical condition characterized by the presence of exposed bone in the maxillofacial region. Its pathogenesis is still undetermined, but may be associated with risk factors such as rheumatoid arthritis (RA). The aim of this paper is to report two unpublished cases of BRONJ in patients with RA and to conduct a literature review of similar clinical cases with a view to describe the main issues concerning these patients, including demographic characteristics and therapeutic approaches applied.Methods: Two case reports of BRONJ involving RA patients were discussedResults: Both patients were aging female taking alendronate for more than 3 years. Lesions were detected in stage II in posterior mandible with no clear trigger agent. The treatment applied consisted of antibiotics, oral rinses with chlorhexidine, drug discontinuation and surgical procedures. Complete healing of the lesions was achieved.Conclusions: This paper brings to light the necessity for rheumatologists to be aware of the potential risk to their patients of developing BRONJ and to work together with dentists for the prevention and early detection of the lesions. Although some features seem to link RA with oral BRONJ and act as synergistic effects, more studies should be developed to support the scientific bases for this hypothesis.

Epidemiological aspects of rheumatoid arthritis patients affected by oral bisphosphonate-related osteonecrosis of the jaws

This literature review aims to evaluate the epidemiologic profile of patients with rheumatoid arthritis (RA) that developed a bisphosphonate-related osteonecrosis that affect the jaws (BRONJ), including demographic aspects, as well as clinical and therapeutic issues. A search of PUBMED/MEDLINE, Scopus, and Cochrane databases from January 2003 to September 2011 was conducted with the objective of identifying publications that contained case reports regarding oral BRONJ in RA patients. Patients with RA who develop oral BRONJ are usually women above 60 years taking steroids and long-term alendronate. Most of them have osteoporosis, and lesions, triggered by dental procedures, are usually detected at stage II in the mandible. Although there is no accepted treatment protocol, these patients seem to have better outcomes with conservative approaches that include antibiotic therapy, chlorhexidine, and drug discontinuation.

Association of body composition and vitamin D levels with cardiac geometric pattern in rheumatoid arthritis patients

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

An essential role for mast cells as modulators of neutrophils influx in collagen-induced arthritis in the mouse

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Methotrexate improves the health-related quality of life of children with juvenile idiopathic arthritis

Objectives: To examine the change in health-related quality of life (HRQOL) and its determinants in children with juvenile idiopathic arthritis (JIA) treated with methotrexate (MTX). Methods: Patients were extracted from the PRINTO clinical trial which aimed to evaluate the efficacy and safety profile of MTX administered in standard, intermediate or higher doses (10, 15 and 30 mg/m2/week respectively). Children with polyarticular-course JIA, who were less than 18 years and had a complete HRQOL assessment were included. Results: A total of 521 children were included. At baseline, patients with JIA showed poorer HRQOL (p<0.01) than healthy children. In 207/412 (50%) and 63 (15%) children, HRQOL values were 2 standard deviations below the mean of healthy controls in the physical and psychosocial summary scale, respectively. After 6 months of treatment with standard dose MTX, there was a statistically significant improvement in all HRQOL health concepts, particularly the physical ones. Similar improvements were observed in those who did not respond to a standard dose of MTX and were subsequently randomised to a higher dose. The presence of marked disability at baseline was associated with a fivefold increased risk of retaining poor physical health after 6 months of active treatment with standard dose MTX. Other less important determinants of retaining poor physical well-being were the baseline level of systemic inflammation, pain intensity and an antinuclear-antibody-negative status. Conclusions: MTX treatment produces a significant improvement across a wide range of HRQOL components, particularly in the physical domains, in patients with JIA.

Uma análise clinimétrica dos índices articular extra-articular do Juvenile Arthritis Damage Index(JADI-A e JADI-E) na artrite isiopática juvenil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Equivalência métrica do Disease Activity Score (DAS 28) e Juvenile Arthritis Disease Activity Score (JADAS) na artrite idiopática juvenil

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Immunomodulation in human and experimental arthritis: including vitamin D, helminths and heat-shock proteins

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Periodontal pathogens directly promote autoimmune experimental arthritis by inducing a TLR2- and IL-1-Driven Th17 response

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)