C. Afonso

Unidade Local de Saúde do Alto Minho, Oporto, Porto, Portugal

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Publications (19)108.46 Total impact

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    ABSTRACT: Large granular lymphocytic (LGL) leukemia is an uncommon, usually indolent, lymphoproliferative disorder strongly associated with various autoimmune diseases. The authors report a case of a 67-year-old woman with a long-standing rheumatoid arthritis, who developed neutropenia and associated recurrent infections, diagnosed with LGL leukemia. We describe the treatment approach and the response to an anti-TNF and the rituximab.
    No preview · Article · Jun 2015 · Acta reumatologica portuguesa
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    ABSTRACT: Background The presence of depression, anxiety and sleep disorders are common among patients with inflammatory rheumatic diseases. Frequently are underdiagnosed in clinical practice and can negatively influence the perception of pain by the patient, the disease activity and the individual's quality of life. Objectives To determine the levels of depression, anxiety and sleep quality in patients with inflammatory rheumatic diseases followed in a rheumatology day-care unit, with current or past history of biological treatment, and to identify associated demographic and disease-related factors. Methods The Beck depression and anxiety inventory (BDI and BAI) and Pittsburgh sleep quality index (PSQI) were applied as instruments for measuring the severity of depression, anxiety and sleep quality, respectively. Disease activity was ascertained using validated clinical index: ASDAS-PCR for spondylarthritis with predominant axial involvement and DAS28-ESR for spondylarthritis with predominant peripheral involvement or rheumatoid arthritis. Health Assessment Questionnaire (HAQ) was used to assess impairment in daily activities due to illness and Short Form-36 (SF-36) to assess health related quality of life. A p value of <0.05 was considered as significant. Results A total of 84 patients were consecutively included, of which 50 (59.5%) were female, with a mean age of 46.25±13.25 years (19 to 85) and a mean disease duration of 14.62±8.07 years (1 to 38). Thirty six (42.9%) patients had rheumatoid arthritis and 48 (57.1%) had spondylarthritis. Symptoms of anxiety and depression were found in 46 (54.8%) and 30 (35.7%) patients, with moderate or severe score in 23 (27.3%) and 14 (16.7%) patients respectively. Thirteen (15.5%) patients were taking antidepressant treatment. Poor sleep quality was found in 53 (63.1%) patients but only 14 (16.7%) took sleeping pills. Strong correlation (p<0.01) was found between high scores of anxiety, depression and sleep index. These scores correlated too with high HAQ and pain on a VAS, low SF36 and both on their mental and emotional components (p<0.01). High ASDAS-PCR scores were positively correlated with anxiety, depression and sleep index (p<0.01). Similarly high DAS-28 positively correlated with depression (p<0.01) and poor sleep quality (p<0.05), but not with anxiety. The female gender and other than single civil status were associated with higher anxiety and history of hypertension with more depressive symptoms (p<0.05). Active employees and current corticosteroid treatment were associated both with higher anxiety and depression scores (p<0.05). Older age and longer disease duration associated with poorer sleep quality (p<0.05). The scores were not statistically different between bDMARDS or cDMARDS, the kind of disease, habits or other associated diseases. Conclusions Anxiety, depression and sleep disorders were very prevalent in this patient group. Higher disease activity, worse quality of life and higher pain were noted in the presence of these disturbances. The female gender, civil status, employment, corticoid therapy and history of hypertension were also associated. Recognize and treat both conditions is important to best manage these patients. Disclosure of Interest None declared
    No preview · Article · Jun 2015 · Annals of the Rheumatic Diseases
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    ABSTRACT: Background The health-related quality of life (HRQL) is an important indicator of the burden of inflammatory rheumatic diseases (IRD). Their outcomes may also be affected by coexisting chronic conditions that can cause functional impairment and activity limitation with significant reductions in HRQL. Objectives To determine the health status and quality of life in patients with IRD followed in a rheumatology day-care unit and to identify associated demographic and disease-related parameters influencing it. Methods The Health Assessment Questionnaire (HAQ) to assess impairment in daily activities due to illness and Short Form-36 (SF-36) to assess HRQL were applied to patients on day-care routine visits. Disease activity clinical measures (DAS28-ESR, ASDAS-PCR, mean pain on VAS) were collected according to the disease and the predominant involvement. A p value of <0.05 was considered as significant. Results A total of 84 patients were consecutively included, predominantly female (59.5%), with a mean age of 46.25±13.25 years (range 19-85) and a mean disease duration of 14.62±8.07 years (1-38). Thirty six (42.9%) patients had rheumatoid arthritis and 48 (57.1%) had spondylarthritis. Seventy seven (91.7%) patients with current bDMARDS, 51 (60.7%) also with cDMARDS and 19 (22.6%) with low doses corticosteroid treatment. Twenty four (28.6%) had associated hypertension, 4 (4.8%) diabetes and 10 (11.9%) dyslipidemia. The mean DAS28-ERS was 2.59±1.06 (0.53 to 6.94), median ASDAS-PCR 1.40±1.15 (0.20 to 5.50), mean pain on a VAS 3.77±2.58 (0 to 10), mean HAQ 0.76±0.71 (0 to 2.88) and mean SF-36 418.71±162.31 (103.50 to 707). Strong correlation (p<0.01) was found between high scores of HAQ and low SF-36. These scores correlated also with older age, high pain on a VAS and high disease activity measured by ASDAS-PCR and DAS28-ESR. Longer disease duration correlated as well with lower level of SF-36 (p<0.05), but not with HAQ. Rheumatoid arthritis showed significant higher levels of HAQ than spondylarthritis. The female gender, current corticosteroid treatment and history of hypertension were associated both with higher HAQ and lower SF-36 (p<0.05). The scores were not statistically different between bDMARDS or cDMARDS, smoking and alcohol consumption, civil or employment status, level of education or other associated diseases. Conclusions Our findings suggest that not only the activity or duration of the disease, but also the gender, concomitant comorbidities and therapies can influence the HRQL and daily activities. The disease activity could be a determinant of disability but is important to incorporate coexisting conditions and demographic data in the evaluation of HRQL. Disclosure of Interest None declared
    No preview · Article · Jun 2015 · Annals of the Rheumatic Diseases
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    ABSTRACT: The Silences of the Archives, the Reknown of the Story. The Martin Guerre affair has been told many times since Jean de Coras and Guillaume Lesueur published their stories in 1561. It is in many ways a perfect intrigue with uncanny resemblance, persuasive deception and a surprizing end when the two Martin stood face to face, memory to memory, before captivated judges and a guilty feeling Bertrande de Rols. The historian wanted to go beyond the known story in order to discover the world of the heroes. This research led to disappointments and surprizes as documents were discovered concerning the environment of Artigat’s inhabitants and bearing directly on the main characters thanks to notarial contracts. Along the way, study of the works of Coras and Lesueur took a new direction. Coming back to the affair a quarter century later did not result in finding new documents (some are perhaps still buried in Spanish archives), but by going back over her tracks, the historian could only be struck by the silences of the archives that refuse to reveal their secrets and, at the same time, by the possible openings they suggest, by the intuition that almost invisible threads link here and there characters and events.
    Preview · Article · Nov 2014 · Revista Brasileira de Reumatologia
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    Preview · Article · Aug 2014 · Revista Brasileira de Reumatologia
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    Preview · Article · Feb 2014 · Revista Brasileira de Reumatologia
  • F. Teixeira · D. Peixoto · M. Bogas · C. Afonso · D. Araujo
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    ABSTRACT: Background Increased cardiovascular morbility and mortality has been observed in several inflammatory rheumatic diseases, namely, rheumatoid arthritis and systemic lupus erythematosus The chronic inflammatory state in these diseases may contribute to accelerated atherosclerosis. ``Ultrasonic biopsy” (U-B) is a described noninvasive screening technique to detect early atherosclerotic plaques and arterial wall changes. Objectives To evaluate the prevalence of subclinical atherosclerosis in patients with Psoriatic Arthritis, examining carotid and femoral arteries and to identify early clinical and biologic markers for these changes in this population. Methods Consecutive PsA patients who fulfilled the CASPAR criteria who were followed at our Rheumatology departmentbwere recruited. Traditional risk factors, biological inflammatory parameters and disease activity scores were checked. We studied 69 patients (39 women and 30 men), with a median age of 53 years (range 23-80yr) and a median disease duration of 96 months (range 18-552months). All patients underwent U-B study of left and right carotid (CA) and femoral artery (FA). The UB features were classified and scored as follows: Class A, normal (score 0); Class B, interface disruption (score 2); class C, intima-media (I-M) granulation (score 4); Class D, plaque without hemodynamic disturbance (score 6); Class E, stenotic plaque (score 8); and Class F, plaque with symptoms (score 10). Results Thirty-three (49%)of the 69 patients had at least a lesion in 1 of the 4 vessels tested (Classe C, D e F), these, 12 (36%) had lesion in 4 vessels. The AF was involved in 27 patients but the CA in only 20 patients. The presence of carotid plaque(classes D-F) correlated significantly with disease duration, LDL and triglyceride levels. Diabetes and hypertension were associated with the presence of plaques (classes D-F). Mean C-reactive protein washigher in classes D-F compared to the class A-B. Conclusions This study evaluates both carotid and femoral arteries in psoriatic arthritis patients looking for subclinical atherosclerosis. The results Our study demonstrates show that patients with PsA may have an increased prevalence of subclinical atherosclerosis. Femoral artery evaluation should be performed and complement the more frequent carotid study as it may show additional information about the atherosclerotic state of the patient. Special attention and strict control of atherosclerotic risk factors in patients with PsA is warranted to prevent future cardiovascular events. Disclosure of Interest None Declared
    No preview · Article · Jan 2014 · Annals of the Rheumatic Diseases
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    ABSTRACT: Background Fatigue is common to all the rheumatic conditions, in varying degrees, and is a frequent, often severe problem that has major consequences on patients life. Objectives To evaluate the fatigue in a group of patients with spondyloarthritis and possible associations with anemia, disease activity index and degree of pain with fatigue experienced by patients. Methods Patient’s demographic data were collected. The Functional Assessment of Chronic Illness Therapy- Fatigue (FACIT F), version 4- Portuguese translation available, was applied for fatigue measurement. Scores range from 0 to 160, with lower scores reflecting greater fatigue. Patients were grouped by predominant axial or peripheral involvement. Clinical measures were collected according to the predominant involvement (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) for the axial and Disease Activity Score in 28 joints- erythrocyte sedimentation rate (DAS28- ESR) for the peripheral). In all, global assessment (PGA) of disease activity, pain on a 0-100-mm visual analog scale (VAS) and laboratory findings were recorded. Correlation studies were performed with Spearman test. Results A total of 51 patients were consecutively included, 32 (62.7%) were male and 19(37.3%) were female, with a mean age of 44.1±13.9 years (17 to 69) and a median disease duration of 137.6±110.1 months (7 to 445). The predominant involvement was axial in 28 (54.9%) patients and peripheral in 23 (45.1%). Nineteen (37.3%) patients were treated with biological therapies and 24 (47.1%) with classical disease-modifying anti-rheumatic drugs (DMARDs). Mean DAS28 was 2.41±1.26 (0.53 to 4.76) and BASDAI 2.78±2.43 (0 to 8.24), mean fatigue question in BASDAI of 3.03±2.98 (0 to 10) and mean BASFI was 3.31±2.89 (0 to 9.3). Mean of PGA and pain scores on a VAS was 31.51±25.44 and 32.57±29.1 respectively. FACIT-F scored from 61 to 158 (mean of 112.37±23.44). Mean FACIT-F was statistically significant lower in women than men (p<0.05) and the functional component of FACIT-F lower in patients with predominant peripheral involvement (p<0.05). Correlation with FACIT-F total score was strongest for BASFI (r= -0.710; p<0.01); BASDAI (r= -0.501; p<0.01); BASDAI-fatigue (r=-0.466; p<0.01), pain (r= -0.505; p<0.01), PGA (r=-0.455; p<0.01) and age (r=-0.404; p<0.01). DAS28, hemoglobin and ESR correlated with the physical component of the FACIT-F (r=-0.538; r=0.356; r=-0.382 with a p<0.05) but not with the total FACIT-F score. Fatigue levels were not significantly different between patients on biologic or other treatments. Conclusions Fatigue is an important symptom in patients with inflammatory arthritis. FACIT-F is a psychometrically sound measure of the fatigue in different domains. The FACIT-F showed a good (negative) correlation with measures of pain, disease assessment and disease function, showing a trend to be lower in patients with higher activity. No association was found with therapy, disease duration, acute-phase reactants or anemia. References Webster k, Cella D, Yost K. The Functional Assessment of Chronic Illness Therapy (FACIT) Measurement System: properties, applications, and interpretation. Health and Quality of Life Outcomes 2003, 1:79 Disclosure of Interest None Declared
    No preview · Article · Jan 2014 · Annals of the Rheumatic Diseases
  • F. Teixeira · D. Peixoto · C. Afonso · D. Araujo
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    ABSTRACT: Background Shoulder pain has been found to be the second most frequent acute musculoskeletal complaint presenting in general practice and the third most common site of musculoskeletal pain in the community. Approximately 10% of people will have one or more episodes of shoulder pain during their lifetime. Although local steroid injections are one of the most common treatments, there is no strong evidence to support their use and they have potential adverse effects. The optimum timing of steroid injections is also still unclear. Objectives To assess the efficacy and safety of steroid injections for patients with shoulder pain at six, 12 and 18 months after subacromial steroid injection, correlate ultrasound changes and with time course of shoulder pain and treatment outcomes. Methods In a prospective study, 86 patients with shoulder pain were evaluated for demographic and clinical data and a visual analog scale (VAS) for pain. In all was performed a shoulder ultrasound. Ultrasound operator evaluated for the presence of rotator cuff tendinopathy, tear or impingement, subacromial bursa fluid or wall thickening, abnormalities of the long head of the biceps tendon, or calcification Seventy-four patients underwent a subacromial corticosteroids injection with methylprednisolone, ultrasound guided. Treatment efficacy was evaluated a one month, six, 12 and 18 months. The primary outcome measure was a 10-cm VAS for shoulder pain intensity. The mean age was 67.9±12.4 years and the men disease duration was 25.5±14.5 months. Results Right shoulder was more commonly involved (74%). Rotator cuff tendinopathy was found in 67%, subacromial bursa fluid in 38%, calcification in 27%, signs of impingement in 42.8%, adhesive capsulitis in 8.9%, partial tears of rotator cuff in 12.5%. Median visual analog scale (VAS) pain score was 8,4 before treatment, 7.7, 5.4 and 4.1 at 6, 12 and 18 months after treatment, respectively. The patients with subacromial bursa fluid showed a significantly greater improvement in VAS scores compared with patients with not had (p<0.05). In patients with nocturnal pain the treatment response was better (p=0,06). In patients with calcifications the response was worse (p<0,05). The patientsunderwent a subacromial corticosteroids injections in first 6 months of disease duration had a better response (p<0, 05) in the shoulder pain reduction. There were no complications observed. Conclusions The subacromial steroid injection was more effective in patients with subacromial bursa fluid, with nocturnal pain and in the first six months of disease. Patients with calcification in ultrasound had a poor response. The subacromial steroid injection was safe, there were no complications observed Disclosure of Interest None Declared
    No preview · Article · Jan 2014 · Annals of the Rheumatic Diseases
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    F. Teixeira · D. Peixoto · J. Costa · C. Afonso · D. Araujo
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    ABSTRACT: Background Lupus is a chronic, remitting and relapsing autoimmune disorder characterized by unpredictable disease flares and remissions. The rate and the severity of flares during course of treatment are important predictors of disease outcome. An essential part of treating patients with SLE is to try to keep the frequency and intensity of flares to a minimum. Objectives To determine the flare rate, etiology, outcome and prognostic factors for SLE flares. Methods One hundred and nine patients with SLE followed by our rheumatology department between 1995 and 2011 were eligible for the study. All patients included fulfilled ACR criteria for SLE. A flare was defined as (according to international consensus for a definition of disease flare in lupus) an increase in disease activity in one or more organ systems involving new or worsening clinical signs and symptoms and/or laboratory measurements. All pre-flare, flare, and post-flare visits were recorded with a SLEDAI score calculated for each visit. The flare rate was calculated by dividing the total number of flares in the cohort by the total follow-up years. We studied 109 patients, 106 female (97.2%) and 3 male (2.8%), with a mean age of 30.2±12.6 years at time of the diagnosis and 40.7±12.4 years in follow-up. In the statistical analysis (fisher exact test and student T test for categorical and continuous variables, respectively), a significant association was considered if p<0, 05. Results Seventy-eight of 109 patients (72%) had at least one flare. Thirty-one patients had more than one flare and 17 patients had 3 or more flares. The average number of flares/patient was 1.7±1.8 and the mean inter-flare time was 13.4±12.3 months. The flare rate in SLE was 0.52 flares/patient-year of follow-up. The median time to first flare from the date of diagnosis was 2.7±1.2 years. The average SLEDAI score during a flare was 11.8±4.2, at the pre-flare visit was 4.7±3.5 and post-flare visit was 5.3±2.7. The average SLEDAI score in the second flare was higher than first flare (13.7±4.4 versus 10,3±3,9, p=0,07), which reflects a bigger severity. The articular (n=47 patients) and renal flares (n=32 patients) occurred most frequently, followed by hematological (n=25 patients), cutaneous (n=17 patients), pericardium and pleural effusions (n=13) and neurological flares (n=5 patients). Patients with arthritis and cytopenia at the time of diagnosis had a significantly higher flare rate than those who did not (p<0, 05). Patients receiving continuous treatment with hydroxychloroquine and low dosis of corticosteroids had less and milder flares than patients without this treatment (p=0,001). In our cohort, infections (43%) and discontinuation of therapy (32%) were the main causes of flares. In 25% of the patients the flare etiology was undetermined. Conclusions In our cohort the flare rate in SLE was 0.52 flares/patient-year of follow-up. Most flares occurred in the first years of disease. The second flare was more severe than first. The articular and hematological involvements at time of diagnosis were more associated with flare rate than other organ involvement. This can be explained by the less intense immunosuppressive therapy in articular and hematological involvement. Continuous treatment with hydroxychloroquine and low dosis of corticosteroids decrease the number and severity of flares. Disclosure of Interest None Declared
    Full-text · Article · Jan 2014 · Annals of the Rheumatic Diseases
  • F. Teixeira · D. Peixoto · J. Costa · C. Afonso · D. Araujo
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    ABSTRACT: Background Systemic sclerosis (SSc) is a connective tissue disease characterized by fibrosis of the skin and internal organs, pronounced alterations in the microvasculature and frequent cellular and humoral immunity abnormalities (1). In clinical practice, patients with SSc occasionally complain of pain in the extremities, such as dysesthesia, burning pain, and autonomic nervous symptoms (1,2).Few studies in SSc include assessments of pain. To date, there are no studies assessing the prevalence of neuropathic pain in SSc (2). Objectives To study the prevalence of neuropathic pain (NP) in the SSc patients and associations between SSc clinical variables and pain in all patients with SSc and in limited cutaneous (lcSSc) and diffuse cutaneous (dcSSc) subsets Methods A total of 42 patients (36 females, 6 males) with a mean age 53.7±15.3 years, diagnosed according to American Rheumatism Association criteria for SSc were evaluated. Patients were classified into SSc subsets (lcSSc ordcSSc) according to the criteria for SSc by Leroy et al. Skin involvement was assessed with the modified Rodnan skin thickness score (MRSS) ranging from 0 to 51. The severity of Raynaud’s phenomenon was assessed with the number of patient-reported episodes in the past week. The severity disease was assessed by systemic sclerosis severity scale (SsSS) range from 0 to 36. The assessment of Hand Function was evaluated by Hand Mobility in SSc (HAMIS), range from 0 to 27 and the quality of life by Heath assessment questionnaire (HAQ). The neuropathic pain was evaluated by the DN4 neuropathic pain questionnaire. Using the DN4 neuropathic pain questionnaire, we divided patients into two groups: first group – patients with non- NP (0-3 points), second group - patients with NP (4-8 points). Results In SSc patients 67% (28 patients) had signs of NP by DN4. The prevalence of NP was higher in the patients who haddiffusecutaneous subsets. Patients with NP had longer disease duration (9.3±6.7years versus 3.8±2.3y, p<0.05) and a higher disease severity (15.3±9.2 versus 5.7±4.1 p<0,05). The modified Rodnan skin thickness score was higher in NP patients group (19.2±6.7 versus 8.6±4.6, p<0.01). The NP patients group had higher functional hand disability (12.6±9.6 versus 3.1±2.5 p<0.05). We found no significant differences between the two groups in quality of life andseverity of Raynaud’s phenomenon. NP presented with numbness 94%, tingling 92%, electric shocks 83%, painful cold 81%, burning 77% and itching 56% in the second group. In neurological examination 79% had hypoesthesia to pinprick and 72% had hypoesthesia to touch. Conclusions The pain syndrome in SSc is complex, because has multiples sources, with the neuropathic component prevailing in a 67% patients. SSc duration, skin thickness, diffuse cutaneous subsets and a disease severity had an impact in neuropathic severity, while severity of Raynaud’s phenomenon raynaud’s and HAQ is not linked to neuropathic pain. More attention to pain and how to best manage it is needed in SSc. Disclosure of Interest None Declared
    No preview · Article · Jan 2014 · Annals of the Rheumatic Diseases
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    ABSTRACT: Background The association between chronic inflammatory diseases and thyroid dysfunction is well recognized. This fact can be attributed to hormonal factors and the presence of a facilitator genetic terrain. Increased prevalence of Hashimoto’s thyroiditis (HT) has been described in rheumatoid arthritis, sjögren’s syndrome and systemic lupus erythematosus1. However, there are few data on the association of this disease in other chronic rheumatic disorders such as spondyloarthritis (SpA). Objectives To assess the prevalence of HT in a group of patients with SpA. Methods We included in this study 62 consecutive patients with SpA and 61 age-matched controls with osteoarthritis, primary osteoporosis or fibromyalgia. From January 2012 until January 2013, blood samples were drawn in all subjects. Thyroid-stimulating hormone, free triiodothyronine, free thyroxine, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), titers of antithyroglobulin (anti-TG) and antithyroid peroxidase (anti-TPO) antibodies were measured. The thyroid ultrasound was performed in all patients with changes in thyroid function tests. Age, gender, disease duration and medical treatments were collected. To assessdisease activity we evaluated the DAS 28 in peripheral SpA and the BASDAI in axial SpA. In the statistical analysis (chi-Square and student T-test for categorical and continuous variables, respectively), a significant association was considered if p<0.05. Results We found thyroid dysfunction in 12.9% of SpA and in 3.3% of controls (p<0.05). Hypothyroidism was more common than hyperthyroidism in both groups. We found anti-TG or anti-TPO positive in 16.1% of SpA and in 6.6% of controls (p=0.05) and the anti-TPO was the most frequent in both groups. The prevalence of HT (antibody positivity and ultrasonographic changes suggestive of thyroiditis) was higher in patients with SpA than in controls (9.7% vs 1.6% respectively, p<0.05). Among patients with SpA, HT was significantly more frequent in patients with peripheral involvement (83.3%) than in those with axial involvement (16.7%) and in patients with disease duration >5 years (p<0.05). Furthermore, patients treated with biologic therapy and those who were treated with ≥2 conventional DMARDs (in association) had significantly more HT (p<0.05). There was no association between subtype of SpA, actual ESR or CRP, the current DAS28 or BASDAI. Conclusions Our study demonstrates that HT occurs in patients with SpA with a higher prevalence than in controls, similarly as described in other chronic rheumatic diseases. Although we did not find association between HT with the current disease activity, the HT was significantly more frequent in patients with peripheral involvement, long disease duration and those treated with biological agents or with highest number of DMARDs. This suggests a possible relationship between HT and the maintenance of the inflammatory process in patients with SpA. These results suggest that thyroid function tests should be part of the clinical evaluation in patients with SpA. Currently, there is no clear explanation for the coexistence of these two diseases therefore further studies are needed to clarify the etiology of this association. References Disclosure of Interest None Declared
    No preview · Article · Jan 2014 · Annals of the Rheumatic Diseases
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    ABSTRACT: Background Treatment satisfaction represents an important outcome as it is related to adherence and willingness to continue treatment. Patients beliefs related to the medication (eg, about side effects and safety) also influence their satisfaction and, consequently, the treatment success. Satisfied patients are more likely to maintain a good relationship with a healthcare provider and report better health status1. Objectives To evaluate the beliefs and satisfaction of our patients with inflammatory rheumatic diseases with their current biological therapies. Methods Forty-one consecutive patients observed at our day-care unit completed an 18-item questionnaire concerning biological treatment. It included questions addressing their perceptions and satisfaction with their current treatment, information provided by their physician and about the knowledge and satisfaction regarding the cost of these therapies. The questionnaire was applied by the nurses to patients and blinded to provide anonymity. The attending physician was previously asked to record the disease state (remission/not remission) of each patient. Results We included 26 females and 15 males, with a mean age of 47.1±11.9 years. Forty six percent of the patients had rheumatoid arthritis, 27% psoriatic arthritis, 22% ankylosing spondylitis and 5% had undifferentiated spondylarthritis. Forty six percent of the patients were treated with etanercept, 29% with adalimumab, 13% with infliximab, 7% with rituximab and 5% with tocilizumab and 85.4% of patients were in clinical remission. Regarding the information provided by their doctor about the treatment, 95% of patients were satisfied, 97.6% responded that this treatment was effective to control the disease and 100% that their quality of life improved with this medication. Concerning safety, although 82.9% considered this drug safe, 56% responded that they had to take special care about their health, 22% believed to have more health complications and 14.6% experienced some side effects. Regarding convenience, 87.8% responded that their treatment frequency was convenient but 46.6% were unsatisfied with the form of administration and 24.4% reported that their treatment form/frequency interfered with their professional life. In relation to costs of the biologic agents,83% of patients considered that they are expensive and 98% didn’t agreed with the price. However when we tried to understand if patients had a correct notion of the cost, 73% of patients responded <1000 euros (€)/month, 46% <500 €/month and 22% said <100 €/month. Conclusions The majority of our patients were satisfied with the information provided by their doctor, considered the treatment effective in controlling the disease, reported improved in quality of life and considered them as safe drugs. In the negative perspective, we emphasize that 46.6% of patients are unsatisfied with the form of administration and 24.4% reported that it interfered with their professional life. Although most patients considered biological agents as expensive drugs, the majority underestimated their real cost, which reinforces the need for continuous education to raise the awareness of patients to avoid oversights/waste with the drug. Disclosure of Interest None Declared
    No preview · Article · Jan 2014 · Annals of the Rheumatic Diseases
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    ABSTRACT: Focal myositis is an acute and localized muscle inflammation of unknown aetiology. The clinical diagnosis is often difficult to obtain, since it can be confused with infections, vascular thrombosis or muscle tumours such as sarcomas. This leads to a significant delay in the diagnosis, resulting in the administration of inappropriate and potentially harmful treatments. We report here a case of recurrent focal myositis in a woman where the diagnosis was only obtained after 6 years, despite multiple hospital admissions. This case reinforces the importance of clinical knowledge and experience to tackle challenging medical scenarios.
    Full-text · Article · Dec 2013 · Acta reumatologica portuguesa
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    Full-text · Article · Oct 2013 · Acta reumatologica portuguesa
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    ABSTRACT: Complex Regional Pain Syndrome type 1 is characterised by neuropathic pain associated with autonomic dysfunctions. It frequently appears after major or minor trauma and more rarely may originate from conditions that compromise the central nervous system. Although few treatments have shown to be effective, their institution at an early stage is decisive for their success. For this reason it is important to ensure timely recognition of this clinical entity, attempting to identify its cause and the predominant underlying physiopathological mechanisms whenever possible. The authors describe a case of complex regional pain syndrome type 1, emphasising the rarity of this clinical situation in association with a Parkinsonian Syndrome.
    No preview · Article · Jul 2012 · Acta reumatologica portuguesa
  • F. Teixeira · D. Peixoto · J. Costa · C. Afonso · D. Araujo
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    ABSTRACT: Background Systemic sclerosis (SSc) is a multisystem disease characterized by immune system activation, fibrosis, and vasculopathy. Because SSc is a complex multisystem disease, pain may have multiple sources, patients with SSc report numerous painful symptoms, including skin breakdown, digital ulcers, Raynaud’s phenomenon, musculoskeletal pain, and gastrointestinal symptom Objectives To estimated prevalence, severity and associations between SSc clinical variables and pain in all patients with SSc and in limited cutaneous (lcSSc) and diffuse cutaneous (dcSSc) subsets. Methods A total of 42 patients (36 females, 6 males) with a mean age 53.7±15.3 years, diagnosed according to American Rheumatism Association criteria for SSc completed a standardized clinical assessment and questionnaires about their physical and psychosocial health, including a pain severity numerical rating scale (NRS; range 0–10). Pain prevalence and severity were estimated with descriptive statistics. SSc clinical variables and pain were estimated with linear regression for the entire group and by SSc subtype. Results Of the patients, 37 (88%) reported pain. Sixteen (39%) had mild pain [NRS 1–4], 11 (27%) moderate pain [NRS 5–7], and 15 [36%] severe pain [NRS 8–10]). Active ulcers, a high modified Rodnan skin thickness score, worse synovitis andgastrointestinal (GI) symptoms were associated with pain in multivariate analysis adjusting for demographic variables, depressive symptoms, and comorbid conditions. Patients with dcSSc reported higher mean ±SD pain than those with lcSSc (dcSSc 5.1±3.4 versus lcSSc 2.7±2.8. Conclusions Pain symptoms were common in the present study of patients with SSc and were independently associated with more active ulcers, worse synovitis, skin thicknessand GI symptoms. Subsetting by extent of skin involvement was related to pain severity variables. Disclosure of Interest None Declared
    No preview · Article · Jun 2012 · Annals of the Rheumatic Diseases
  • F. Teixeira · D. Peixoto · M. Bogas · C. Afonso · D. Araújo
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    ABSTRACT: Tethered Cord Syndrome is a rare disorder, which is usually diagnosed in childhood, since it is a congenital abnormality. It is characterized by the tethering of the spinal cord inside the spinal canal to the intra or extradural structures, hindering its longitudinal movement. It may be associated with other occult spinal dysraphisms and can lead to chronic neurogenic lesions and significant neurological deficiencies. The diagnosis is more difficult in adults, because symptoms are rare, unspecific, and appear slowly. The authors report a case of a 25-year-old patient, which was observed in the rheumatology department due to an increased level of creatine phosphokinase found in routine blood tests. The patient had no additional symptoms and the clinical follow-up led to Tethered Spinal Cord Syndrome diagnosis. It is important to reinforce that, in the absence of symptoms, clinical evaluation was merely oriented by the changes found during patient examination.
    No preview · Article · Jan 2011 · Sinapse

  • No preview · Article · Oct 2010 · Acta reumatologica portuguesa