Long-Term Safety and Efficacy of Abatacept in Children With Juvenile Idiopathic Arthritis

Objective. We previously documented that abatacept was effective and safe in patients with juvenile idiopathic arthritis (JIA) who had not previously achieved a satisfactory clinical response with disease-modifying antirheumatic drugs or tumor necrosis factor blockade. Here, we report results from the long-term extension (LTE) phase of that study.Methods. This report describes the long-term, open-label extension phase of a double-blind, randomized, controlled withdrawal trial in 190 patients with JIA ages 6-17 years. Children were treated with 10 mg/kg abatacept administered intravenously every 4 weeks, with or without methotrexate. Efficacy results were based on data derived from the 153 patients who entered the open-label LTE phase and reflect >= 21 months (589 days) of treatment. Safety results include all available open-label data as of May 7, 2008.Results. of the 190 enrolled patients, 153 entered the LTE. By day 589, 90%, 88%, 75%, 57%, and 39% of patients treated with abatacept during the double-blind and LTE phases achieved responses according to the American College of Rheumatology (ACR) Pediatric 30 (Pedi 30), Pedi 50, Pedi 70, Pedi 90, and Pedi 100 criteria for improvement, respectively. Similar response rates were observed by day 589 among patients previously treated with placebo. Among patients who had not achieved an ACR Pedi 30 response at the end of the open-label lead-in phase and who proceeded directly into the LTE, 73%, 64%, 46%, 18%, and 5% achieved ACR Pedi 30, Pedi 50, Pedi 70, Pedi 90, and Pedi 100 responses, respectively, by day 589 of the LTE. No cases of tuberculosis and no malignancies were reported during the LTE. Pneumonia developed in 3 patients, and multiple sclerosis developed in 1 patient.Conclusion. Abatacept provided clinically significant and durable efficacy in patients with JIA, including those who did not initially achieve an ACR Pedi 30 response during the initial 4-month open-label lead-in phase.

Technique for Indexing an Immediate Loading Implant Position for a Provisional Restoration

The transfer of an intraoral implant position to the cast for an immediate loading implant is an important step and may be difficult to achieve with commonly used transfer and impression methods. Thus, the purpose of this report is to describe a technique for the use of a surgical template to transfer the implant position for fabrication of a provisional restoration. This technique simplifies the procedure, eliminates the need for taking an impression, avoids surgical site contamination, and maintains an adequate emergence profile during fabrication of the definitive restoration. An indexing technique for transferring the position of the implant from the treated surface after extraction is described.

The use of transitional implants to support provisional prostheses during the healing phase: a literature review

Objective: Transitional implants are indicated for cases in which immediate loading is counter-indicated because a healing period is necessary for osseointegration of the definitive implants. These provisional implants were developed to support an implant-supported fixed prosthesis or overdenture to provide retention, stability, and support. The aim of this article was to conduct a literature review on transitional implants to highlight the characteristics of the transitional implants and their advantages, indications, and contraindications, including the level of osseointegration of such implants according to the functional period. Method and Materials: The present literature review was based on the OldMedline and Medline databases from 1999 to 2010 using the key words "transitional implants" and "temporary implants." Fourteen articles were found: 11 clinical studies or techniques and three histologic and histomorphometric studies. Results: The transitional immediate prostheses were worn by completely and partially edentulous patients. Advantages of transitional implants include complete denture retention, stability, and support; maintenance of chewing, phonetics, and patient comfort; protection of bone grafts; vertical stop during healing period; easy and fast surgical and prosthetic procedures; lower cost in comparison to the definitive implant; and reestablishment of esthetics. The success of transitional implants as conservative treatment for conventional immediate loading is a reality if correctly indicated. Conclusion: Transitional implants are a provisional treatment alternative for completely and partially edentulous patients. However, additional studies are required to evaluate the level of remodeling and repair of the transitional implants under loading. (Quintessence Int 2011; 42: 19-24)

Influence of TNF-alpha blockers on the oral prevalence of opportunistic microorganisms in ankylosing spondylitis patients

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

Multi-criteria spatial decision analysis for demarcation of greenway: A case study of the city of Rio Claro, São Paulo, Brazil

Concern regarding hydrological resources has been a theme of growing importance in Brazil, associating the development of new management policies and maintenance of natural areas related to rivers. An efficient way to maintain natural areas around rivers has been the development of greenways, and some cites have already adopted specific legislation in this respect. Following this growing evolution in the treatment of hydrological resources, this study was carried out to demarcate a greenway along the Corumbatai River in the state of São Paulo, Using multi-criteria analysis in a GIS environment. First, thematic maps were elaborated based on Landsat 7 satellite, aerial photographs and digital topographic base, Supported by field activities. With the use of multi-criteria analysis, for which ad hoe consultations were conducted to attribute weights to the thematic maps, a suitability map was elaborated for the allocation of the greenway. Sites that should be included in the greenway were also selected, such as areas appropriate for leisure activities, and ecologically important areas. Based on the suitability map, a pathway analysis was done, connecting the relevant points of interest, thus generating a greenway that runs along the Corumbatai River, with the aim of contributing to the conservation of this important hydrological resource. (c) 2007 Elsevier B.V. All rights reserved.

Criteria for peanut seed pre-conditioning for the tetrazolium test

The staining pattern of peanut (Arachis hypogaea L.) seeds with a tetrazolium solution was evaluated to determine the adequate conditions of seed quality evaluations. Three seed lots with different vigour levels and similar moisture content were pre-conditioned using the combination of five periods of time (4, 8, 12, 16 and 20 hours) and four temperatures (20, 25, 30 and 35 degrees C) and then exposed to a 1.0% tetrazolium solution for three hours. The moisture content levels of seeds conditioned for 8 hours at the temperatures of 25, 30 or 35 degrees C, for 12 hours at 20 or 25 degrees C and for 16 hours at 20 degrees C, were above 30%. In this range of moisture level, the staining in tetrazolium was clear and uniform, reflecting an appropriate conditioning of the seeds. However, under a practical point of view, the period of 16 hours at 20 degrees C showed to be the best option, since it allows to start the pre-conditioning an late afternoon of one day and submit the seeds for staining in the following morning.

Criteria for mixed grids in computational fluid dynamics

The finite volume method is used as a numerical method for solving the fluid flow equations. This method is appropriate to employ under structured and unstructured meshes. Mixed grids, combining both types of grids, are investigated. The coupling of different grids is done by overlapping strategy. The computational effort for the mixed grid is evaluated by the CPU-time, with different percentage of covering area of the unstructured mesh. The present scheme is tested for the driven cavity problem, where the incompressible fluid is integrated by calculating the velocity fields and computing the pressure field in each time step. Several schemes for unstructured grid are examined, and the compatibility condition is applied to check their consistency. A scheme to verify the compatibility condition for the unstructured grids is presented. (c) 2006 IMACS. Published by Elsevier B.V. All rights reserved.

Risk factors for amenorrhea in juvenile systemic lupus erythematosus (JSLE): a Brazilian multicentre cohort study

We evaluated the prevalence and clinical associations of amenorrhea in 298 female juvenile systemic lupus erythematosus (JSLE) patients (ACR criteria) followed in 12 Brazilian Paediatric Rheumatology centres. Amenorrhea was observed in 35 patients (11.7%) with a mean duration of 7.2 +/- 3.6 months. The hormones were performed in 32/35 patients and none of them had FSH and LH levels above and estradiol below the normal range according to pubertal changes. JSLE patients with amenorrhea were younger (15.04 +/- 2.5 versus 17.8 +/- 3.1 years; P = 0.001), and had a shorter period of time between menarche and current age (3.4 +/- 2.9 versus 6.7 +/- 5.4 years; P = 0.001). Interestingly, the frequency, cumulative dose, number of pulses and duration of intravenous cyclophosphamide treatment were alike in patients with and without amenorrhea (P > 0.05). In contrast, patients with amenorrhea had significantly higher SLEDAI (P = 0.01) and SLICC/ACR-DI (P = 0.024) scores compared to those without this condition. Independent risk factors identified by multivariate analysis were higher SLEDAI (OR=1.059; CI=1.004-1.116; P=0.034) and SLICC/ACR-DI (OR=2.125; IC = 1.373-3.291; P = 0.001) scores. Our data suggest that in spite of imummosuppressive therapy, JSLE patients have an adequate ovarian follicular reserve and amenorrhea is particularly associated with disease activity and damage.

Criteria for the diagnosis of diffuse uterine myohypertrophy

Objectives: Diffuse uterine myohypertrophy (DUMH) is a condition clinically diagnosed by the presence of uterine bleeding, homogeneous and diffuse uterine enlargement, and absence of any myoendometrial cause of bleeding. Since the morphologic criteria for the diagnosis of this entity are still controversial, this study aimed to investigate the clinical presentation and the morphologic findings of the cases of DUMH presenting at the University Hospital of Botucatu, São Paulo, Brazil, Methods: We retrospectively studied 43 consecutive patients with DUMH submitted to hysterectomy (test group) and compared the findings with those obtained from 28 patients submitted to hysterectomy due to a prolapsed uterus (control group). There were no significant differences in age, weight or height between the two groups. Results: the uterine weight of the DUMH group (mean +/- S.D. 157.4 +/- 46.4 g) was significantly heavier than that of the control group (99.5 +/- 35.4 g) and myometrial thickness was significantly greater in the DUMH group (2.5 +/- 0.5 cm) than in the control group (1.9 +/- 0.4 cm). No positive correlation was observed between increased uterine weight and parity, but there was a positive correlation between uterine weight and myometrial thickness. on the basis of the present study, we suggest that the diagnosis of DUMH be made clinically and in cases of uterine weight greater than or equal to 120 g and myometrial thickness greater than or equal to 2.0 cm. In addition, 10 cases of each group were analyzed by morphometry to evaluate interstitial fibrosis and myometrial hypertrophy. The data showed that the increase in uterine weight in DUMH is caused by enlargement of individual myometrial fibers rather than accumulation of interstitial collagen. Conclusion: Discriminant analysis to estimate the diagnostic significance of a number of clinical and pathologic variables (age, parity, uterine weight and morphometric parameters) was able to differentiate cases of DUMH from controls in 100% of the patients.

Proxy-reported health-related quality of life of patients with juvenile idiopathic arthritis: Pediatric rheumatology international trials organization multinational quality of life cohort study

Objective. To investigate the proxy-reported health-related quality of life (HRQOL) and its determinants in patients with juvenile idiopathic arthritis (JIA).Methods. In this multinational, multicenter, cross-sectional study, HRQOL of patients with JIA was assessed through the Child Health Questionnaire (CHQ) and was compared with that of healthy children of similar age from the same geographic area. of joint inflammation, Childhood Health Assessment Questionnaire (CHAQ), and erythrocyte sedimentation rate.Results. A total of 6,639 participants (3,324 with JIA and 3,315 healthy) were enrolled from 32 countries. The mean SD physical and psychosocial summary scores of the CHQ were significantly lower in patients with JIA than in healthy children (physical: 44.5 +/- 10.6 versus 54.6 +/- 4.0, P < 0.0001; psychosocial: 47.6 +/- 8.7 versus 51.9 +/- 7.59 P < 0.0001), with the physical well-being domain being most impaired. Patients with persistent oligoarthritis had better HRQOL compared with other subtypes, whereas HRQOL was similar across patients with systemic arthritis, polyarthritis, and extended oligoarthritis. A CHAQ score > 1 and a pain intensity rating > 3.4 cm on a 10-cm visual analog scale were the strongest determinants of poorer HRQOL in the physical and psychosocial domains, respectively.Conclusion. We found that patients with JIA have a significant impairment of their HRQOL compared with healthy peers, particularly in the physical domain. Physical well-being was mostly affected by the level of functional impairment, whereas the intensity of pain had the greatest influence on psychosocial health.

Paediatric rheumatology - A global perspective

This chapter aims to give a global perspective to paediatric rheumatology. The main points covered are the incidence, recognition of paediatric autoimmune diseases, and ethnic/geographic distribution. The most prevalent disease is juvenile idiopathic arthritis; robust data are still required for childhood-onset systemic lupus erythematosus, dermatomyositis, and scleroderma. Mimicking or overlapping infections are a major challenge in developing countries, and immunization policies in our patients in these areas need specific attention. The delivery of paediatric rheumatology care is also overviewed. Discrepancies in health-care resources and priorities are found in developing countries. Although most anti-rheumatic treatments are available worldwide, they are prohibitively expensive in many countries. For more traditional antirheumatic drugs there is still an ongoing need for good core outcome data across the world to ensure valid comparisons. Parent/patient education has been implemented worldwide in paediatric rheumatology through the power of the Internet. Physician and undergraduate training goals must be met to facilitate competent musculoskeletal assessment, a proper understanding of age-dependent variations, diagnosis, referral to specialists, and improved standards of care.

HLA-DR in Brazilian patients with polyarteritis nodosa (PAN) and microscopic polyangiitis (MPA)

The aim of this study was to evaluate the frequency and clinical associations of HLA-DR alleles in Brazilian Caucasian patients with polyarteritis nodosa (PAN) or microscopic polyangiitis (MPA). We evaluated 29 Caucasian patients with vasculitis classified as PAN or MPA according to the American College of Rheumatology (ACR) 1990 Criteria, Chapel Hill Consensus Conference (CHCC) nomenclature for vasculitis and EULAR recommendations for conducting clinical studies in systemic vasculitis. HLA-DR alleles were typed using polymerase chain reaction-amplified DNA, hybridized with sequence-specific low resolution primers. DNA obtained from 59 Caucasian healthy blood donors were used as control. In order to evaluate if a specific HLA may have influence on the clinical profile of those diseases, we also divided the patients according to Birmingham vasculitis score (BVAS) and Five-Factors Score (FFS) at the time of diagnosis. Increased frequency of HLA-DRB1*16 (p = 0.023) and DRB4*01 (p = 0.048) was found in patients with higher disease activity at the time of diagnosis (BVAS >= 22). Patients with less severe disease (FFS = 0) had a higher frequency of HLA-DRB1*03 (p = 0.011). Patients with gastrointestinal tract involvement had significantly increased frequency of HLA-DRB1*11 or B1*12 (p = 0.046), B1*13 (p = 0.021) and B3 (p = 0.008). In contrast, patients with renal disease, had higher frequency of DRB1*15 or DRB1*16 (p = 0.035) and B5 (p = 0.035). In the subgroup of patients with MPA, increased frequency of HLA-DRB1*15 was found in patients with BVAS >= 22 (p = 0.038) and FFS >= 1 (p = 0.039) suggesting that this allele is associated with more aggressive disease. Antineutrophil cytoplasmic antibodies (ANCA) negative MPA patients had significantly increased frequency of HLA-DRB1*11 or DRB1*12 when compared to ANCA positive patients (p = 0.023). Our results suggest that HLA-DR alleles may influence PAN and MPA clinical expression and outcome and that in MPA they participate in the mechanisms involved in the development to ANCA.