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Biomedical subjects

E Atra

Publications and source records attributed to E Atra.

At least 19 recordsLinked to original sources
PubMed1997

Renal abnormalities in ankylosing spondylitis.

Renal abnormalities have been reported in Ankylosing Spondylitis (AS) patients. Possible mechanisms include the effects of nonsteroidal anti-inflammatory drugs (NSAIDs), an increased incidence of glomerulonephritis, particularly the ones associated with deposition of IgA-containing immune complexes and the renal deposition of amyloid. These observations prompted us to evaluate in detail the frequency and severity of renal dysfunction in 40 AS patients, consecutively selected attending the rheumatology disease unit outpatient clinic at Escola Paulista de Medicina, using sensitive tests of glomerular and tubular function. Fourteen of the 40 patients presented one or more signs of renal involvement: microscopic hematuria (9 patients), microalbuminuria (4 patients), decreased renal function assessed by serum creatinine (2 patients), and creatinine clearance (4 patients). None of the patients presented increased urinary excretion of retinol binding protein (RBP). The finding of renal abnormalities in 35% of our patients suggests that in this illness evidence of renal involvement should be actively investigated.

Adolescent↗
PubMed1996

Availability of over-the-counter drugs for arthritis in Sao Paulo, Brazil.

Seventy pharmacies located in Sao Paulo were randomly selected and visited. Seven researchers posed as ordinary clients presenting with a standardized complaint of symptoms according to a scenario previously defined. The client asked for medicines to relieve his/her pain or discomfort. After the seller's suggestion the client asked for 2 drugs randomly selected from a drug list containing 30 trademarked drugs commonly prescribed to arthritis patients. These drugs should be available only on prescription. In only 12.8% of the pharmacies did the seller initially suggest the client see a physician. The sellers "prescribed' non-steroid anti-inflammatory drugs (NSAID), vitamins, analgesics (AN) and corticosteroids (CO) in respectively 42.8, 20.0, 14.3 and 5.7% of the visits. From the drug list, the client secured 67.7% of the NSAID, 65.0% of the CO and 20.0% of the sedatives without presenting a prescription. Pharmacy sellers usually comply with the clients demands. Future studies should aim at the evaluation of interventions to reduce the availability of the over-the-counter drugs for arthritis.

Adult↗
PubMed1996

A randomized double-blind controlled trial of sulphasalazine combined with pulses of methylprednisolone or placebo in the treatment of rheumatoid arthritis.

Thirty-eight patients with rheumatoid arthritis meeting American College of Rheumatism (ACR) criteria were entered in a randomized controlled trial (RCT) of 6 months to assess whether monthly treatment with i.v. methylprednisolone (MP) enhances or accelerates the efficacy of sulphasalazine (SSZ). All patients had failed at least one second-line agent and were randomized to receive SSZ (2g/day) and pulses of MP (5 mg/kg), or SSZ+ (2 g/day) and pulses of saline (SA). A single infusion of 2 h was carried out in both groups for a total of three times (0, 1 and 2 months). The two groups were comparable at baseline regarding their demographic and clinical characteristics. Disease activity was evaluated every 2 months by means of: (1) joint count; (2) morning stiffness; (3) grip strength; (4) visual analogue pain score; (5) health assessment questionnaire; and (6) erythrocyte sedimentation rate. All outcome measures improved significantly in both groups (P < 0.001). Evaluation at each follow-up visit showed no significant differences between the groups in any of the adverse effects attributable to SSZ therapy (one SA vs two MP). Adverse effects attributable to SA/MP therapy were rare and mild. We concluded that repeated pulses of MP during the first 3 months of treatment did not improve the efficacy of SSZ. Therefore, there is no justification for using MP in this way during the induction phase of SSZ therapy.

Adult↗
PubMed1996

Controlled trial with chloroquine diphosphate in systemic lupus erythematosus.

INTRODUCTION: Antimalarials have been recognized as effective drugs for the treatment of articular and cutaneous manifestations of systemic lupus erythematosus (SLE), but its potential in the management of systemic features of the disease has not yet been thoroughly evaluated. OBJECTIVES: This study intended to evaluate the efficacy of chloroquine diphosphate (CDP) in preventing flares and in reducing the maintenance corticosteroid dose in patients with SLE without life-threatening manifestations. MATERIALS AND METHODS: Twenty-four SLE patients with no life-threatening manifestation were enrolled in a 12-month double blind placebo-controlled trial with CDP (250 mg/day). Patients were subjected each month to clinical examination by a rheumatologist and to SLE-relevant laboratory tests. At each visit, prednisone dose could be adjusted according to the clinical status. Ophthalmologic examination was performed every six months. Outcome measures included SLEDAI score and the required prednisone dose. SLE flare was defined as an increase in SLEDAI score of at least three points. Prednisone dose reduction was defined as a minimum 50% dose decrease with no concomitant disease flare. RESULTS: Twenty-three patients completed the study. One patient in the placebo (PL) group dropped out due to severe dyspepsia. No major side-effect was observed in the remaining patients. PL and CDP groups showed no significant difference at the beginning of the study with regard to sex, age, ethnic classification, disease duration, SLEDAI and prednisone dose. Along the trial the prednisone dose became progressively lower in CDP group as compared to PL group and the difference reached statistical significance at 4, 6 and 12 months. SLEDAI score was higher in PL group in all evaluations, being the difference statistically significant at 4 months. Flare-up episodes were registered in two patients in CDP group and in ten patients in PL group. The estimated reactivation risk was 4.6 times greater in PL group as compared to CDP group. CONCLUSIONS: CDP at a 250 mg/day dose was able to prevent disease exacerbation, reduce the required prednisone dose, and help inducing a better control of patients with non life-threatening SLE. These data suggest that antimalarials might have a broader indication in the treatment of SLE other than solely the management of skin and articular manifestations.

Adult↗
PubMed1995

Bone density in white Brazilian women: rapid loss at the time around the menopause.

Dual energy x-ray absorptiometry (DXA) was used to measure bone mineral density (BMD) of the lumbar spine and proximal femur (neck, Ward's triangle, and trochanter) in 417 normal women (aged 20-79) living in São Paulo, Brazil. Bone density decreased with age at all sites. At the spine, the greatest decrease occurred during the sixth decade, with an average 11.4% bone loss compared with the previous decade. Stratifying the subjects according to menopausal status revealed that the fastest bone loss occurred at the time around the menopause (ages 45-60) when the rate of bone loss (-0.66%/year) was almost twice as rapid as in postmenopausal women (-0.39%/year). Although significant linear rates of bone loss were detected in all proximal femur sites before the menopause, a menopause-dependent pattern was less evident than at the spine. Lifetime rates of bone loss at the appendicular skeleton were -0.43, -0.62, and -0.35%/year at the femoral neck, Ward's triangle, and trochanteric area, respectively. After the menopause, BMD declined with menopausal age at all sites, although the rate of bone loss was faster at the femoral neck (-0.62%/year) and Ward's triangle (-0.84%/year) than at the spine (-0.49%/year). The results are consistent with the notion that in women, the fastest bone loss occurs at the time around the menopause, most likely consequent to ovarian failure; and that faster rates of bone loss are detected at the proximal femur than at the lumbar spine in late postmenopausal women.

Absorptiometry, Photon↗
PubMed1995

Psychological aspects of Brazilian women with fibromyalgia.

In order to determine the occurrence of psychological disturbances the authors studied 47 women who fulfilled the American College of Rheumatology Criteria for the classification of fibromyalgia and 25 random selected control patients without chronic muscle pain, all of whom live in Sorocaba, SP, Brazil. Personality disturbances were observable in 63.8% of the patients and 8.0% of the control group (p < 0.05); depression in 80.0% of the fibromyalgia group and 12.0% of the controls (p < 0.05) and anxiety in 63.8% of the patients and 16.0% of the controls (p < 0.05). The Hamilton test mean scores showed higher values for depression and anxiety among the fibromyalgia patients when compared to the control group. A significant association between fibromyalgia and depression, anxiety and personality disturbances was studied and recorded.

Adolescent↗
PubMed1995

Sensitivity and specificity of different diagnostic criteria for Behçet's disease according to the latent class approach.

In this study, we estimated the sensitivity and specificity of different criteria (International, Japanese, Mason & Barnes, O'Duffy, James and clinical judgement) for Behçet's Disease using the latent class approach. Thirty-two consecutive Behçet's Disease patients who were initially diagnosed according to clinical judgement, and 56 control patients with other rheumatic diseases, were recruited from the rheumatology out-patient clinic. The patients had their charts reviewed, were interviewed and clinically examined. Various models including different combinations of the six diagnostic criteria were tested. In the model that included all the information gathered, the International (sensitivity = 0.95, specificity = 1.00), Japanese (sensitivity = 1.00, specificity - 0.95) and Mason & Barnes criteria (sensitivity = 1.00, specificity = 0.94) were the most accurate. Clinician judgement also performed very well in identifying a Behçet's Disease case (sensitivity = 1.00, specificity = 0.85). The International, Japanese and Mason & Barnes criteria were the most accurate. The latent class method led to these conclusions without making any initial assumptions about the accuracy of any of the competing criteria (including clinical judgement).

Adult↗
PubMed1995

The use of focus group interview in the evaluation of patients with ankylosing spondylitis.

The purpose of this study was to develop some of the focus group discussion (FGD) potentialities in order to provide information on patients' understanding of the origin and management of their medical condition. Fifteen ankylosing spondylitis (AS) patients (mean age = 32.6 yr and mean disease duration = 13.4 yr) were selected from the Rheumatic Disease Unit (RDU) out-patient clinic at Escola Paulista de Medicina, São Paulo, Brazil, to take part in this study. The FGD constituted two sessions, with eight patients in the first and seven in the second. The moderator raised specific questions about the patients' understanding of the pathology, the treatment and how the illness affected their quality of life. It was observed through the FGD that patients believed that their illness onset was due to some physical trauma. Clinicians should inquire about this tissue to be sure that their individual patients do not have this false belief. Also, it is necessary to improve the methods for early diagnosis and to develop further studies to determine and assess the parameters of disease activity. And finally, FGD may be of use in establishing a self-help group for individuals with chronic diseases, such as AS. In conclusion the FGD is an available technique that should be used more frequently in medicine to gather global qualitative data.

Adult↗
PubMed1995

Upper-extremity Musculoskeletal Disorders in Keyboard Operators in Brazil: A Cross-sectional Study.

This study sought to determine the prevalence of upper-extremity musculoskeletal disorders (UEMSDs) among keyboard operators in Sao Paulo, Brazil, and to compare this prevalence with that among other office workers. One hundred and thirty keyboard operators (mean age 33 years, 60 male/70 female) and 138 office workers (mean age 35 years, 82 male/56 female) from two computing centers were interviewed by a research assistant using a standardized questionnaire. Symptomatic subjects, defined as those who reported upper extremity pain or lost work time due to pain in the preceding 12 months, were examined by a rheumatologist. Mean (SD) lengths of employment were 9 (6) years for keyboard operators and 8 (6) years for office workers. Upper-extremity pain during the preceding seven days was reported by 66 keyboard operators (51%) and by 18 office workers (13%) (p < 0.0001); during the preceding 12 months, by 90 keyboard operators (69%) and by 26 office workers (19%) (p < 0.0001). UEMSDs were diagnosed following physical examination in 50 keyboard operators and in 12 office workers (9%) (p < 0.0001). Tenosynovitis was the most common disorder diagnosed among the keyboard operators (n = 23). Among the keyboard operators the prevalence of UEMSDs was significantly lower for males (p = 0.017, OR = 0.38, 95%CI = 0.17-0.86). The presence of a diagnosed UEMSD was significantly associated with duration of employment (p = 0.005) and lack of or insufficient rest breaks (p = 0.012). Keyboard operators had significantly more UEMSDs than did office workers. Strategies aimed at the reduction of repetitive strain injuries among keyboard operators, such as the provision of adequate work breaks, should be evaluated.

Journal Article↗
PubMed1995

The role of ambiental agents in Behçet's disease.

OBJECTIVE: To evaluate the potential role of environmental agents in the etiopathogenesis of Behçet's disease. METHODS: Twenty-eight Behçet's disease patients and 56 controls were recruited prospectively from the outpatient rheumatic disease clinic at the Escola Paulista de Medicina between July 1991 and July 1992. Behçet's disease was diagnosed using one of the accepted sets of criteria (Japanese Committee, International Committee, O'Duffy, Mason & Barnes, and James). The control patients, who had other rheumatic diseases, were matched on age and sex with the Behçet's disease patients. To investigate environmental factors, a standardized questionnaire was administered to each subject during an interview. Clinical and laboratory investigations were performed in each subject according to a predefined protocol. RESULTS: Analysis using the Chi-square test or Fisher's exact test (Cochran's restriction) disclosed significant associations between Behçet's disease and a history of herpes simplex virus type 1 infection or streptococcal infection. CONCLUSIONS: Despite the small sample size, our data strongly support a role of infectious agents in the etiopathogenesis of Behçet's disease. Further studies in larger patient populations are needed to confirm our results.

Adolescent↗
PubMed1995

Fibromyalgia versus rheumatoid arthritis: a longitudinal comparison of the quality of life.

OBJECTIVE: To evaluate and compare the quality of life of patients with fibromyalgia (FM) and rheumatoid arthritis (RA). METHODS: Forty-four women with FM and 41 with RA were studied. There were 3 evaluations, with a 3-month interval. Besides special and general clinical examinations, the following tests were applied: pain numerical scale (PNS), Health Assessment Questionnaire (HAQ), Fibromyalgia Impact Questionnaire (FIQ), Arthritis Helplessness Index (AHI), Modified Post-Sleep Inventory (PSI), and questions about sleep disorders and socioeconomic impact. RESULTS: Results include the following: tender points (TP): FM = 13.9, RA = 2.9; PNS: FM = 7.2, RA = 6.8; HAQ: FM = 0.90, RA = 1.22; FIQ: FM = 47.2, RA = 42.5; AHI: FM = 32.7, RA = 31.8; sleep quality--mean duration of daily sleep: FM = 6.7 h, RA = 6.1; PSI scores: FM = 64.6, RA = 57.2. On questioning regarding economic impact, there was a decrease in family income for 65% of patients with FM and 75.1% for those with RA. Fifty-five percent of patients with FM and 66.6% of those with RA received social security aid. At followup evaluation, there was a statistically significant improvement in the following items for the patients with FM: TP count, HAQ, and AHI. The patients with RA improved in number of TP and AHI. CONCLUSION: FM has a negative impact on quality of life, similar to RA. Clinical, functional, and economic problems related to the disease were observed. The alteration observed remained relatively stable during the study period, except for physical disability.

Adult↗
PubMed1994

Combination therapy with methotrexate and chloroquine in rheumatoid arthritis. A multicenter randomized placebo-controlled trial.

To compare the efficacy of the combination therapy Methotrexate (MTX) and Chloroquine (CHLO) with MTX and Placebo (PLA) in the treatment of Rheumatoid Arthritis. A total of 82 patients with Rheumatoid Arthritis (RA), diagnosed according to the American College of Rheumatology criteria, received orally either MTX 7.5 mg/week and CHLO 250 mg/day or MTX 7.5 mg/week and PLA 1 tablet/day. Adverse effects (AE) were monitored monthly and disease activity was assessed at 0, 2, 4 and 6 months. Sixty-eight patients completed the study. All outcome measures improved significantly in both treatment groups. Patients receiving MTX/CHLO ended the study with a significantly lower joint count, greater grip strength and better functional ability the patients in the MTX/PLA group, respectively; 4.5 vs 7.5 (P < 0.05), 113.3 vs 89.1 (P < 0.05) and 0.636 vs 0.811 (P < 0.05). Mild AE were more frequently observed in the MTX/CHLO, 17 events in 15 patients, compared to 9 events in 8 patients in the MTX/PLA group (NS). These data indicate that MTX/CHLO is slightly more efficacious and toxic than is MTX/PLA in the treatment of RA.

Adult↗
PubMed1994

[Estimation of benefits and risks of the treatment of rheumatoid polyarthritis with glucocorticoids using the health-related quality of life measurements].

The purpose of this study was to use the utility approach to evaluate the risks and benefits of corticosteroid therapy in rheumatoid arthritis patients. The utility approach provides us with a quantitative measure of the value or preference a patient attaches to his overall health status defined on a scale from perfect health (1) to death (0). Benefits and toxicity are combined into a number reflecting the patients combined assessment of the benefits of treatment and the side-effects associated with it. Utility of 3 scenarios (rheumatoid arthritis patients treated respectively with no, 5 mg/day and 15 mg/day of prednisone) were determined through the time trade-off (TTO) and thermometer scale (TS) techniques. Twenty-five rheumatoid arthritis patients selected at random among subjects attending an outpatient clinic and 25 rheumatologists were interviewed using visual aids. Treatment with 15 mg/d prednisone was assigned the highest utilities by both patients and physicians. Coefficients of correlation between thermometer scale and time trade-off utilities were 0.675 (p < 0.01) for physician-assigned utilities and 0.518 (p < 0.05) for patient-assigned utilities. Medical decisions concerning rheumatoid arthritis patients should take into account the preferences of patients and physicians.

Adult↗
PubMed1993

[Infantile scleroderma. Apropos of 11 cases].

Scleroderma is uncommon in children and adolescents. Eighty-four cases have been reported. With reference to a new series of 11 cases, the clinical features and course of the disease are described. Prognosis was good. There have been no deaths and none of the patients have significant visceral organ damage.

Adolescent↗
PubMed1993

Wa idiotype in seropositive rheumatoid arthritis.

Antibodies against cross-reactive idiotypes (CRIs) may prove useful as phenotypic tracers of immunoglobulin variable region genes (VH or VL). CRIs of human rheumatoid factors (RFs) seem to be useful in the elucidation of the incidence and structural characteristics of the latter. Anti-Wa CRI antibodies were produced and an enzyme immunoassay was developed to test polyclonal RFs isolated from sera of 20 rheumatoid arthritis (RA) patients, 7 males and 13 females, aged 17 to 74 years. Seventeen patients had clinically active disease and three were in remission. Disease duration ranged from 1 to 25 years and RF titers ranged from 1:160 to 1:640. The immunoassay could detect as little as 8 ng of a monoclonal purified WaRF and positive results were found in 30% of patient sera. Therefore, we may conclude that at least part of the RFs seen in RA patients derives from germ line genes.

Adolescent↗