Ana Filipa Mourão's research while affiliated with Centro Hospitalar de Lisboa Ocidental and other places
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Publications (134)
Background
Juvenile idiopathic arthritis (JIA) treatment is aimed at inducing remission to prevent joint destruction and disability. However, it is unclear what is the long-term impact on health-related outcomes of the timing of biological disease-modifying antirheumatic drug (bDMARD) initiation in JIA. Our aim was to evaluate the long-term impact...
Objectives
The main goal of this study was to characterise the frequency and phenotype of B, T follicular helper (Tfh) and T follicular regulatory (Tfr) cells in peripheral blood and the cytokine environment present in circulation in children with extended oligoarticular juvenile idiopathic arthritis (extended oligo JIA) and polyarticular JIA (poly...
Background
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children. Our group has recently demonstrated that extended oligoarticular and polyarticular JIA mostly evolve to a rheumatoid arthritis (RA)-like phenotype in adulthood. Disturbances in B cells, T follicular helper (Tfh) and T follicular regulatory (Tfr) cell im...
Background
Acro-osteolysis is a disabling manifestation of Systemic Sclerosis (SSc). Few is known about its prevalence and clinical associations.
Objectives
To define the prevalence of acro-osteolysis among Portuguese SSc patients, to determine the most sensitive radiological location for its diagnosis and to clarify the phenotype of SSc patients...
Introduction/objectives:
The study aims to define the clinical and subclinical calcinosis prevalence, the sensitivity of radiographed site and clinical method for its diagnosis, and the phenotype of Portuguese systemic sclerosis (SSc) patients with calcinosis.
Method:
A cross-sectional multicenter study was conducted with SSc patients fulfilling...
Backgroud: Juvenile idiopathic arthritis (JIA) treatment is aimed at inducing remission to prevent joint destruction and disability. However, it is unclear what is the long-term impact on health-related outcomes of the timing of biological disease-modifying anti-rheumatic drug (bDMARD) initiation in JIA. Our aim was to evaluate the long-term impact...
Arthritis in the paediatric population is the hallmark of many rheumatic inflammatory diseases, as well as other cutaneous, infectious, or neoplastic conditions. It can be quite devastating, whereby prompt recognition and treatment of these disorders are essential. However, arthritis can sometimes be mistaken for other cutaneous or genetic conditio...
Clinically amyopathic dermatomyositis (CADM) is a rare condition characterized by dermatomyositis skin lesions without clinically apparent muscle involvement. Respiratory involvement is common, occurring in about half of the cases. Spontaneous pneumomediastinum (PnM) is a rare, and often fatal, complication of CADM. We report a case of a 61-year-ol...
Introduction:
Coronavirus Disease 2019 (COVID-19) generally appears to have milder clinical symptoms and fewer laboratory abnormalities in children. It remains unknown whether children and young people with inflammatory chronic diseases who acquire SARS-CoV-2 infection have a more severe course, due to either underlying disease or immunosuppressiv...
Background
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children ¹ . Our group has recently demonstrated that extended oligoarticular (eoJIA) and polyarticular JIA (pJIA) mostly evolve to a rheumatoid arthritis (RA) like phenotype in adulthood ² . Disturbances in B cells, T follicular helper (Tfh) and T follicular reg...
Background
Rheumatic diseases are associated with an increase in overall risks of tuberculosis (TB). The aim of this study was to evaluate the frequency of TB and the frequency of latent TB infection (LTBI), in clinical practice, for juvenile idiopathic arthritis (JIA) patients from high and low risk of TB incidence endemic countries.
Methods
This...
Cat scratch disease (CSD) is a zoonosis caused by Bartonella henselae, which is usually transmitted to humans through scratches or bites from infected cats. It is primarily a disease of children and adolescents, although it can affect individuals of any age. In approximately 10% of cases, patients can present atypical manifestations that may involv...
Objective:
To identify predictive factors of relapse after discontinuation of Methotrexate (MTX) in Juvenile Idiopathic Arthritis (JIA) patients with inactive disease.
Methods:
We conducted a prospective multicenter cohort study of patients diagnosed with JIA using real world data from the Portuguese national register database, Reuma.pt. Patient...
Objective
To compare physical disability, mental health, fatigue and health-related quality of life (HRQoL) across juvenile idiopathic arthritis (JIA) categories in adulthood and between JIA and adult-onset rheumatic diseases.
Methods
Cross-sectional analysis nested in a cohort of adult patients with JIA registered in the Rheumatic Diseases Portug...
CD4+ T cells mediate rheumatoid arthritis (RA) pathogenesis through both antibody-dependent and independent mechanisms. It remains unclear how synovial microenvironment impinges on CD4+ T cells pathogenic functions. Here, we identified a TLR4+ follicular helper T (Tfh) cell-like population present in the blood and expanded in synovial fluid. TLR4+...
Background
The outcomes of the infection by the SARS-CoV-2 in patients with immune-mediated inflammatory diseases were largely unknown during the early days of the COVID-19 pandemic. It was hypothesized that these patients were at higher risk of morbidity and mortality due to their inherent immune dysfunction and immunosuppressive therapy. Several...
Background
Juvenile idiopathic arthritis (JIA), one of the most common chronic diseases in children, can be classified in seven different categories according to its onset presentation. Concerns about pregnancy outcomes play a secondary role in disease approach. However, recent data showed an increased risk of pre-term birth in women with JIA inste...
Objective:
To investigate the relationship between body mass index (BMI) and disease activity in patients with Juvenile Idiopathic Arthritis (JIA).
Methods:
Patients with JIA, aged ≤18 years, registered at the Rheumatic Diseases Portuguese Register (Reuma.pt) in Portugal and Brazil were included. Age- and sex-specific BMI percentiles were calcul...
Objective:
The aim of this study was to evaluate the self-reported impact of mandatory confinement occurring in the first wave of the SARS-CoV-2 pandemic in Portuguese patients with rheumatoid arthritis (RA), as a means to improve care during this and in future pandemics.
Material and methods:
The web-based survey COVIDRA was developed to assess...
CD4+ T cells mediate rheumatoid arthritis (RA) pathogenesis through both antibody-dependent and independent mechanisms. It remains unclear how synovial microenvironment impinges on CD4+ T cells pathogenic functions. Here, we identified a TLR4+ follicular helper T (Tfh) cell-like population present in the blood and expanded in synovial fluid. Mechan...
Coronavirus disease 2019 (COVID-19) was reported in Europe in the beginning of February 2020. Typical symptoms included fever, cough and dyspnea, and not much was known about the clinical evolution of the disease. Herein, we report a case of a late complication of COVID-19 infection in a 41-year-old female. The patient presented with a 4-day histor...
Background
Methotrexate (MTX) is the most widely used conventional synthetic disease-modifying antirheumatic drug (csDMARD) in the treatment of juvenile idiopathic arthritis (JIA). 1,2 When remission is achieved, questions remain about discontinuing MTX. There is some evidence that a longer period of inactive disease before MTX withdrawal is associ...
Objectives
To compare definitions of high disease activity of the Ankylosing Spondylitis Disease Activity Score (ASDAS) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in selecting patients for treatment with biologic disease-modifying antirheumatic drugs (bDMARDs).
Methods
Patients from Rheumatic Diseases Portuguese Register (Reum...
Benign transient hyperphosphatasemia of infancy and early childhood is a self-limiting condition characterized by transiently increased serum alkaline phosphatase in the absence of liver, kidney or metabolic bone diseases. It is often accidentally found in children under five years old and it might be associated with a variety of underlying clinica...
Background
The influence of body mass index (BMI) on Juvenile Idiopathic Arthritis (JIA) disease activity is poorly understood. In adults with Rheumatoid Arthritis, obesity has been associated with higher disease activity, while in JIA patients, a previous study has failed to find any association.
Objectives
To investigate the relationship between...
Background
Pain and stiffness are characteristic clinical features of axial Spondyloarthritis (axSpA), leading to functional impairment. Patients describe beneficial effects of physical activity, suggesting a possible involvement of muscle tissue. Body composition data in young axSpA patients with short disease duration are scarce and its implicati...
Background
A BASDAI ≥4 has been often required to start TNFi therapy in patients with axSpA. However, this cut-off of high disease activity (HDA) is largely arbitrary. Unlike BASDAI, ASDAS incorporates objective measures (e.g. CRP) and has a validated definition of HDA (≥2.1). It has thus been suggested that ASDAS could also be used to guide treatm...
Background:
Advances in osteoporosis (OP)case definition, treatment options, optimal therapy duration and pharmacoeconomic evidence in the national context motivated the Portuguese Society of Rheumatology (SPR) to update the Portuguese recommendations for the diagnosis and management of osteoporosis published in 2007.
Methods:
SPR bone diseases'...
Objective: To update the recommendations for the treatment of rheumatoid arthritis (RA) with biological therapies, endorsed by the Portuguese Society of Rheu -matology (SPR). Methods: These treatment recommendations were formulated by Portuguese rheumatologists based on litera -ture evidence and consensus opinion. At a national meeting the 11 recom...
Objective:
To describe the contribution of Reuma.pt to the knowledge of systemic immune-mediated rheumatic diseases.
Results:
Reuma.pt is widely implemented, with 77 centres actively contributing to the recruitment and follow-up of patients. Reuma.pt follows in a standardized way patients with the following systemic inflammatory rheumatic diseas...
Biosimilars are new and more affordable similar versions of previously approved reference biological drugs. Following the approval of the first monoclonal antibody biosimilar in 2013, the Portuguese Society of Rheumatology issued a position paper on the use of biosimilars in rheumatic conditions covering efficacy, safety, extrapolation, interchange...
P368 Introduction: Idiopathic musculoskeletal pain (IMP) is related to a negative impact in the quality of life of children and adolescents sleep problems and psychosocial factors seem to be involved in its pathogenesis, which is not fully known. Restless legs syndrome (RLS), periodic limb movements (PML) and sleep problems were observed in adults...
Background
Persistence on medication mainly reflects both effectiveness and safety of a drug. Understanding the reasons to stop bDMARD in routine clinical practice can help to better define the efficacy and safety of biologic medications in children with juvenile idiopathic arthritis (JIA).
Objectives
To investigate persistence on treatment and th...
Background:
Methotrexate (MTX) is the first-line drug in the treatment of rheumatoid arthritis (RA) and the most commonly prescribed disease modifying anti-rheumatic drug. Moreover, it is also used as an adjuvant drug in patients under biologic therapies, enhancing the efficacy of biologic agents.
Objectives:
To review the literature and update...
Objective:
To update the recommendations for the treatment of Rheumatoid Arthritis (RA) with biological therapies, endorsed by the Portuguese Society of Rheumatology (SPR).
Methods:
These treatment recommendations were formulated by Portuguese rheumatologists based on literature evidence and consensus opinion. At a national meeting the 10 recomm...
Fabry’s disease (FD) is a lysosomal storage disorder associated with an alpha-galactosidase A deficiency. The prevalence of FD among juvenile idiopathic arthritis (JIA) patients with established diagnosis is unknown, but as musculoskeletal pain may be an important complaint at presentation, misdiagnosed cases are anticipated. With this study, we ai...
Objectives:
To assess the effectiveness of subcutaneous Golimumab 50 mg/monthly combined with methotrexate (SC GLM + MTX) over 52 weeks of treatment, in biologic-na?ve RA patients, in a multicentre nationwide cohort from the Rheumatic Diseases Portuguese Register (Reuma.pt).
Methods:
Data for this observational study was collected from March 201...
Objectives
To determine how adult juvenile idiopathic arthritis (JIA) patients fulfil classification criteria for adult rheumatic diseases, evaluate their outcomes and determine clinical predictors of inactive disease, functional status and damage.
Methods
Patients with JIA registered on the Rheumatic Diseases Portuguese Register (Reuma.pt) older...
Objective: To provide evidence-based guidance for the rational and safe prescription of biological therapies in children and adolescents with juvenile idiopathic arthritis (JIAs) considering the latest available evidence and the new licensed biologics.
Methods: Rheumatologists and Pediatricians with expertise in Pediatric Rheumatology updated the...
Background
Registries are becoming an increasingly important source of data, providing additional information on the use of biologics in clinical practice. The real-world clinical data currently available regarding the use of SC anti-TNFs is still limited. Therefore, it is of utmost importance to increase the knowledge of Golimumab (GLM) effectiven...
Background
Ankylosing Spondylitis (AS) typically affects young people, leading to progressive deterioration of physical function and quality of life (QoL) with higher use of healthcare services. Work disability and early retirement is also higher in AS patients than in the general population, with a remarkable negative impact on productivity and so...
Objectives:
To estimate the national prevalence of rheumatic and musculoskeletal diseases (RMDs) in the adult Portuguese population and to determine their impact on health-related quality of life (HRQoL), physical function, anxiety and depression.
Methods:
EpiReumaPt is a national health survey with a three-stage approach. First, 10 661 adult pa...
Objectives:
Assess the effectiveness and safety of biologic therapy as well as predictors of response at 1 year of therapy, retention rate in biologic treatment and predictors of drug discontinuation in JIA patients in the Portuguese register of rheumatic diseases.
Methods:
We prospectively collected patient and disease characteristics from pati...
This study aimed to assess the genetic determinants of poor outcome in Portuguese patients with juvenile idiopathic arthritis (JIA).
Methods.
Our study was conducted in Reuma.pt, the Rheumatic Diseases Portuguese Register, which includes patients with JIA. We collected prospectively patient and disease characteristics and a blood sample for DNA ana...
Background Rheumatic and musculoskeletal diseases (MSKD) are a prevalent leading cause of disability and consume a large amount of healthcare and social resources. MSKD have been associated with low levels of physical and mental health in other countries.
Objectives To estimate the national prevalence of hand, knee and hip osteoarthritis (OA), low...
Background Inconsistencies of classification, barriers in transition of care and lack of integrated paediatric and adult registries, has contributed to incomplete understanding of adult impact of Juvenile Idiopathic Arthritis (JIA).
Objectives To determine which JIA patients registered in Rheumatic Diseases Portuguese Register (Reuma.pt) fulfill cl...
Background Fabry's disease (FD) is a lysosomal storage disorder initiated by sphingolipid accumulation owing to a deficiency of the enzyme a-galactosidase A (a-Gal A). Classically affected males present with pain (more frequently, acroparestesias in the extremities, but also episodes of joint pain associated with fever and high erythrocyte sediment...
Background Genetic variants have been identified associated with the susceptibility to Juvenile idiopathic arthritis (JIA). Little is known about the genetic determinants of disease severity and long-term outcomes.
Objectives This study aimed to assess the genetic determinants of poor outcome in Portuguese patients with JIA.
Methods Our study relie...
Objectives To assess the effectiveness and safety of biological therapy as well as predictors of response after 1 year of therapy, the retention rate in biological treatment and predictors of drug discontinuation in JIA patients registered in the Portuguese register of rheumatic diseases, Reuma.pt.
Methods We collected prospectively patient and dis...
Rheumatic and musculoskeletal diseases (RMD) are prevalent and leading causes of disability and consumption of healthcare and social resources. EpiReumaPt is a national population-based survey developed by the Portuguese Society of Rheumatology that aimed to estimate the prevalence of RMDs and determine their impact on function, quality of life, me...
The aim of this article was to describe and discuss several strategies and standard operating procedures undertaken in the EpiReumaPt study - which was the first Portuguese, national, cross-sectional population-based study of Rheumatic and Musculoskeletal Diseases (RMD).
The technical procedures, legal issues, management and practical questions wer...
Juvenile idiopathic arthritis (JIA) refers to a heterogeneous group of illnesses that have in common the occurrence of chronic joint inflammation in children younger than 16 years of age. The diagnosis is made only on clinical assessment. The identification of antibody markers could improve the early diagnosis, optimizing the clinical management of...
Background The Portuguese Society of Rheumatology developed the Rheumatic Diseases Portuguese Register (Reuma.pt) encompassing also Juvenile Idiopathic Arthritis patients followed by rheumatologists and pediatricians.
Objectives 1. To obtain an overview of biological agents use in Portuguese children with JIA. 2. To assess the effectiveness and saf...
Objective
Our aims were to evaluate the correlation between Juvenile Arthritis Disease Activity Score 27-joint reduced count (JADAS27) with erythrocyte sedimentation rate (ESR) and JADAS27 with C-reactive protein (CRP) scores and to test the agreement of both scores on classifying each disease activity state. We also aimed at verifying the correlat...
Background Intra-articular (IA) corticosteroids injections are used in mono- or oligoarthritis in rheumatoid arthritis (RA) and other aseptic inflammatory joint diseases. IA triamcinolone hexacetonide (TH) is used most often as a supplement to systemic anti-inflammatory therapy.
Objectives To compare the clinical and ultrasound (US) morphology resp...
Background Recently, a composite score named Juvenile Arthritis Disease Activity Score (JADAS) was found to be a valid instrument for assessment of disease activity. JADAS was developed with erythrocyte sedimentation rate (ESR) because C-reactive protein (CRP) values were not available in all databases used to validate the tool. However, as the aut...
Purpose: To report an atypically severe and refractory phlyctenular keratoconjunctivitis case treated successfully with systemic biologic immunosuppressive therapy.
Methods: A 10-year-old female was followed in the ophthalmology clinic for three years for a severe form of bilateral PKC. The patient was treated for blepharitis and intestinal parasit...
Objective:
To develop Portuguese evidence-based recommendations for the Diagnosis and Management of Gout.
Methods:
As part of the 3e Initiative (Evidence, Expertise and Exchange), a panel of 78 international rheumatologists developed 10 relevant clinical questions which were investigated with systematic literature reviews. MEDLINE, EMBASE, Cochr...
Background The identification of predictive factors of poor response to methotrexate (MTX) in juvenile idiopathic arthritis (JIA) patients could contribute to optimize the treatment strategy, namely by the earlier introduction of biological treatments.
Objectives To identify baseline clinical or laboratorial predictive factors of MTX poor response...
Background The main goal of juvenile idiopathic arthritis (JIA) treatment is to achieve a long-term remission or, at least, low levels of disease activity.
Objectives To evaluate disease activity, focusing on achievement inactive disease (ID) or minimal disease activity (MDA), based on Juvenile Arthritis Disease Activity Score (JADAS) score, after...
Human leukocyte antigen (HLA)-B27 is the mostly known major histocompatibility complex (MHC) gene associated with ankylosing spondylitis (AS). Nonetheless, there is substantial evidence that other MHC genes appear to be associated with the disease, although it has not yet been established whether these associations are driven by direct associations...
Objective:
B cells play important roles in rheumatoid arthritis (RA). Given the beneficial effect of B cell depletion therapy in RA as well as the observed alterations in B cell subpopulations in this disease, we evaluated whether changes in the expression of genes related to B cell survival and activation were already present in patients with unt...
Objectives:
Adalimumab, etanercept and infliximab are effective TNF inhibitors (TNFis) in the treatment of RA, but no randomized clinical trials have compared the three agents. Prior observational data are not consistent. We compared their effectiveness over 1 year in a prospective cohort.
Methods:
Analyses were performed on subjects' first epis...
Objective:
To update the Portuguese recommendations in order to assist the rational and safe prescribing of biological therapies in children and adolescents with Juvenile Idiopathic Arthritis (JIA) as more evidence and experience with these drugs are available.
Methods:
The recommendations were formulated by Rheumatologists and Pediatricians, wi...
Introduction:
Rheumatic diseases (RD) are conditions with a variety of clinical manifestations and prognosis influenced by several factors. Cohorts and registries have been already established in some countries and have contributed to important knowledge about the disease course and the long-term outcomes of RD. This paper introduces the CoReumaPt...
Background Ankylosing Spondylitis (AS), adversely affect patients in terms of pain, function, and quality of life. AS have a significant influence on individual employment status and work-related productivity, in addition to the significant burden on patients, their families and to society.
Objectives Our aim was to estimate the influence of socio-...
Background Anti-tumor necrosis factor (TNF) therapies have been shown to be highly effective in the treatment of pediatric rheumatic patients. The experience from long term follow up of adult patients treated with anti TNF drugs have identified the occurrence of infections and immune mediated reactions possibly related with the use of these therapi...
Objectives: To develop Portuguese evidence-based recommendations for pain management by pharmocotherapy in inflammatory arthritis. Methods: The Portuguese project was integrated in the multinational 3E Initiative (Evidence, Expertise, Exchange) 2010 where a total of 453 rheumatologists from 17 countries have participated. The clinical questions con...
Objectives:
To develop Portuguese evidence-based recommendations for pain management by pharmocotherapy in inflammatory arthritis.
Methods:
The Portuguese project was integrated in the multinational 3E Initiative (Evidence, Expertise, Exchange) 2010 where a total of 453 rheumatologists from 17 countries have participated. The clinical questions...
The availability of population-specific normative data regarding disease severity measures is essential for patient assessment. The goals of the current study were to characterize the pattern of ankylosing spondylitis (AS) in Portuguese patients and to develop reference centile charts for BASDAI, BASFI, BASMI and mSASSS, the most widely used assess...
Unconfirmed reports describe association of ankylosing spondylitis (AS) with several candidate genes including ANKH. Cellular export of inorganic pyrophosphate is regulated by the ANK protein, and mutant mice (ank/ank), which have a premature stop codon in the 3' end of the ank gene, develop severe ankylosis. We tested the association between singl...
Our goal was to test the performance of the new American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria for the classification of rheumatoid arthritis (RA) in a cohort of patients with very recent onset polyarthritis.
Untreated polyarthritis patients with less than 6 weeks of duration were enrolled. All patients w...
The authors review the practical aspects of biological therapy use for rheumatoid arthritis patients, commenting safety issues before and after treatment initiation and the best treatment strategies to optimize efficacy.
The authors present the revised version of the Portuguese Society of Rheumatology (SPR) guidelines for the treatment of Rheumatoid Arthritis (RA) with biological therapies. In these guidelines the criteria for introduction and maintenance of biological agents are discussed as well as the contraindications and procedures in the case of nonresponders...
Supplementary Table S2: Characteristics of subjects involved in TLDA study. AS (n = 78) and healthy controls (n = 78). No significant differences for age and sex between groups.
Supplementary Table S1: Characteristics of subjects involved in microarrays study. BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; BASFI, Bath Ankylosing Spondylitis Functional Index; BASMI, Bath Ankylosing Spondylitis Metrology Index; mSASSS, modified Stoke Ankylosing Spondylitis Spinal Score.
Supplementary Table S3: Genes differentially expressed between AS patients and controls by microarrays. A total of 648 probes were considered significantly differentially expressed (80% confidence level of false discovery rate with 10% false positives).
A number of genetic-association studies have identified genes contributing to ankylosing spondylitis (AS) susceptibility but such approaches provide little information as to the gene activity changes occurring during the disease process. Transcriptional profiling generates a 'snapshot' of the sampled cells' activity and thus can provide insights in...
Background
We have previously reported an increase in interleukin (IL)-1β levels in very recent onset arthritis. Therefore, molecular mechanisms that regulate IL-1β secretion, such as caspase-1 activation, might play a relevant role in arthritis onset and progression.
Objectives
Our main goal was to evaluate caspase-1 state of activation in early...
Background
The reasons for the phenotypic differences between spondyloarthritis (SpA) and rheumatoid arthritis (RA) are still unclear. Slight divergences in cytokine networks driving the pathologies might contribute to the distinct clinical manifestations and may represent new treatment opportunities.Objectives
The main goal of this work was to com...
Background
B cells play several important roles in rheumatoid arthritis (RA). Previous studies by our group have demonstrated that very early rheumatoid arthritis (VERA) patients have disturbances in peripheral blood memory B cells and increased circulating B cell related cytokines.
Objectives
The main goal of this work was to analyse the expressi...
The study of the descriptive epidemiology of chronic widespread pain (CWP) in several countries is of interest, as the occurrence of this condition varies among different populations. However, reports of pain prevalence are not consensual: it is clear that chronic musculoskeletal pain is frequent all over the world, varying from 4.2% to 13.3%. The...
Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease characterized by sustained synovitis. Recently, several studies have proposed neutrophils and Th17 cells as key players in the onset and perpetuation of this disease. The main goal of this work was to determine whether cytokines driving neutrophil and Th17 activati...
Thirty-seven patients were included. During the follow up most of the patients evolved into RA (57%). The median age of the patients of the RA-group was similar to the median age of the non-RA group (median (IQR) 47 (31-58.5) vs 43 (34-69) years, p=0.74). At the initial visit the DAS 28 in the RA group was significantly higher than in the non-RA gr...
Citations
... However, the real prevalence and clinical features of calcinosis in SSc patients are yet to be adequately defined. Indeed, calcinosis is often subclinical, that is, found to be much more extensive on imaging (e.g., plain radiography) than determined by clinical examination alone [17,18]. ...
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... The clinical and imaging findings are typical of pachydermodactyly, which is a benign acquired form of digital fibromatosis, characterized by compact hyperkeratosis and thickening of the Elektronischer Sonderdruck zur persönlichen Verwendung dermis typically affecting adolescent boys [13,14]. Although of unknown etiology, an association with repetitive mechanical trauma or hormonal dysfunction has been reported [13,14]. ...
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... In contrast, studies of children with rheumatologic diseases did not show a significant correlation with critical COVID-19, though these studies were limited by small sample sizes (Supplemental Figures 18 and 19). Further analysis that considered data from an additional 7 case series, encompassing 1,278 children with rheumatologic conditions, revealed a pooled hospitalization rate of 6% (95% CI: 3%-10%) [62,64,65,81,95,133,134,[144][145][146][147]. The largest study in this subset, which included 607 children, did not find an independent correlation between hospitalization and the use of diseasemodifying anti-rheumatic drugs or glucocorticoids [64]. ...
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... Studies from Brazilian and Portuguese registries have revealed that approximately 10.6% of children are infected with tuberculosis [62]. Therefore, it is essential to actively exclude TB infection when children with JIA present with symptoms such as hypothermia, wasting, and night sweats. ...
... 3,4 Currently, remission is a realistic goal of JIA treatment 5 and tapering or withdrawal of systemic treatment when remission has been achieved is part of standard care management. [6][7][8][9][10][11][12][13] The systemic treatment of JIA includes oral or intravenous corticosteroids, synthetic disease-modifying antirheumatic drugs (sDMARDs), mainly methotrexate (MTX), and biologic DMARDs (bDMARDs). 14,15 In clinical practice, there is some evidence supporting the withdrawal of MTX, particularly in bDMARD-naïve patients, and with a low risk of flare. ...
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... A third of young adults with JIA suffered an arthritis relapse within the first few years after transitioning to adult care, despite most of the cohort being treated with DMARDs both in childhood and adulthood. This is consistent with previous findings of similar rates of active disease in adulthood [9,17,18]. Although the outcomes were not influenced by disease subtype, age of onset, ANA, rheumatoid factor positivity or HLB27 positivity, they were by the occurrence of monoarthritis across disease subtypes. ...
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... is trend was consistent with the messenger ribonucleic acid (mRNA) and protein expression of TLR4, NF-κB, and inflammatory factors. e analysis of this result showed that TLR4 was composed of three parts as follows: the L9-25 Leucine-rich Repeat (LRR) outside the membrane, the intermediate transmembrane region and the Toll-IL-1R domain inside the membrane [13]. TLR4 interacts with MyD88 conjugate-like proteins through TIR domain to activate IRAK, and the activated IRAK will further interact with TRAF to form a complex with the dimer ubiquitin complexase UBC13-UBC like protein Uevl, which jointly catalyzes the formation of K63 ubiquitin chain and activate TAK1 [14]. ...
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... Other web-based surveys of people with RA have had a similar bias to inclusion of women. 5,[8][9][10][11][12] The mean age of 44 years with mean disease duration of 8 years suggests a relatively young patient sample, which makes sense because young people tend to be more computer literate and to participate in social media. There is the potential for patients who are high reporters of side effects to self-select themselves for participation in this study. ...
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... Demographic, disease-related and environmental factors could contribute to the variability in clinical response to TNFi. Some factors have been associated with a poor response such as smoking, [9][10][11][12] being a woman, 10 13 14 older age, 15 16 obesity, 17 presence of rheumatoid factor (RF) and anticitrullinated protein ...
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... Moreover, MR studies have helped in understanding racial, ethnic, and geographical variations in JIA. [21,[48][49][50] Linkage studies have focused on families with multiple affected members to identify genetic risk loci or regions for JIA, contributing to the identification of genetic regions of interest. [51][52][53] Genes associated with juvenile idiopathic arthritis's monogenic forms. ...
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