Browsing by Author "Machado, P"
Now showing 1 - 10 of 13
Results Per Page
Sort Options
- Applying science in practice: the optimization of biological therapy in rheumatoid arthritisPublication . Ramiro, S; Machado, P; Singh, JA; Landewé, RB; Pereira da Silva, JAMost authorities recommend starting biological agents upon failure of at least one disease-modifying agent in patients with rheumatoid arthritis. However, owing to the absence of head-to-head studies, there is little guidance about which biological to select. Still, the practicing clinician has to decide. This review explores the application of published evidence to practice, discussing the goals of treatment, the (in) ability to predict individual responses to therapy, and the potential value of indirect comparisons. We suggest that cycling of biological agents, until remission is achieved or until the most effective agent for that individual patient is determined, deserves consideration in the current stage of knowledge.
- Arthritis and X-linked agammaglobulinemiaPublication . Machado, P; Santos, A; Faria, E; Silva, J; Malcata, AB; Chieira, CPrimary immunodeficiencies are defined as genetically determined functional and/or quantitative abnormalities in one or more of the components of the immune system. Immunodeficiency and arthritis can be related, although the mechanisms are not always clear. Different causes for immunodeficiency can secondarily be found in patients with arthritis; on the other hand, arthritis can be a manifestation of primary immunodeficiency. Arthritis occurs chiefly in humoral primary immunodeficiencies, namely in X-linked agammaglobulinemia and common variable immunodeficiency, and may be one of the warning signs for primary immunodeficiency. We report a case of arthritis as the presenting feature of X-linked agammaglobulinemia. In X-linked agammaglobulinemia, arthritis may be a consequence of infection, most notably by Mycoplasma, or of immune dysfunction itself. In children, and occasionally in young adults, a combination of arthritis and hypogammaglobulinemia should suggest primary immunodeficiency, although other causes of hypogammaglobulinemia must be excluded. Physicians evaluating patients with arthritis should be aware of this fact so that an early diagnosis can be pursued as it is of extreme importance in the optimal management and prognosis of these patients.
- Both structural damage and inflammation of the spine contribute to impairment of spinal mobility in patients with ankylosing spondylitisPublication . Machado, P; Landewé, R; Braun, J; Hermann, KG; Baker, D; van der Heijde, DOBJECTIVE: To study the relationship between spinal mobility, radiographic damage of the spine and spinal inflammation as assessed by MRI in patients with ankylosing spondylitis (AS). METHODS: In this subanalysis of the Ankylosing Spondylitis Study for the Evaluation of Recombinant Infliximab Therapy cohort, 214 patients, representing an 80% random sample, were investigated. Only baseline data were used. MRI inflammation was assessed by the AS spinal MRI activity (ASspiMRI-a) score, structural damage by the modified Stoke AS Spine Score (mSASSS) and spinal mobility by the linear definition of the Bath Ankylosing Spondylitis Metrology Index (BASMI). Univariate correlations were calculated on baseline values using Spearman rank correlation. Independent associations between the variables of interest were investigated by multivariate linear regression analysis. Associations with clinical disease activity, C-reactive protein, disease duration, age, gender, body mass index and HLA-B27 status were also investigated. Subanalyses were performed according to disease duration. RESULTS: BASMI correlated moderately well with mSASSS (Spearman's rho=0.6) and weakly with ASspiMRI-a (rho=0.3). A best-fit model for BASMI included both mSASSS (regression coefficient (B)=0.865, p<0.001) and ASspiMRI-a (B=0.236, p=0.018). In patients with a disease duration < or = 3 years, B was greater for ASspiMRI-a than for mSASSS (0.595 vs 0.380), while in patients with a disease duration > 3 years B was greater for mSASSS than for ASspiMRI-a (0.924 vs 0.156). CONCLUSION: Spinal mobility impairment in AS is independently determined both by irreversible spinal damage and by reversible spinal inflammation. Spinal mobility impairment is more influenced by spinal inflammation in early disease, and by structural damage in later disease
- Characterization of patients with ankylosing spondylitis in hidrokinesitherapy - a multidimensional assessmentPublication . Januário, F; Almeida, J; Serra, S; Amaral, C; Machado, P; Rodrigues, LAOBJECTIVES: Clinical, functional and working characterization of an Ankylosing Spondylitis (AS) group of patients that perform hydrotherapy regularly in a physical and rehabilitation department. Assessment of the benefit of hydrotherapy in symptom relief, function and consumption of analgesics and non-steroidal anti-inflammatory drugs (NSAIDs). MATERIAL AND METHODS: A transversal characterization of a group of patients with SA undergoing hydrotherapy was performed. Demographic, clinical (including disease activity, function and health-related quality of life), radiographic and laboratorial data was collected. A questionnaire about working situation, presence of dyspnoea, smoking, number of sessions and benefit of hydrotherapy was applied. RESULTS: 22 patients (73% males) were enrolled in the study, mean age 55.6 ± 8.8 years, mean duration of the disease 28.0 ± 13.13 years. Apart from the axial involvement, 50% had a previous history of enthesitis, 54.5% peripheral arthritis, 18% dactylitis and 36% uveitis. At the day of assessment, 81% had low-back pain complaints (39% inflammatory rhythm), 18% oligoarthritis, 9.1% had total hip and/or knee prosthesis. The majority of the patients had active disease, accentuated functional deterioration and reduced health related quality of life. About 54.5% were retired due to disability, 18.2% were smokers and 36.4% had dyspnoea; 31.8% presented restrictive ventilatory alterations; 36.4% obstructive (predominance in the small airways); 13.6% mixed and in 18.2% the spiromety was normal. The mean total time of hydrotherapy was 13 ± 6.8 years. The patients attended a mean of 3 sessions per week and 3 series of 15 sessions per year. Of the 22.7% that performed another physical activity, 80% walked and 20% cycled. The ingestions of analgesics (p < 0.05) and NSAIDs (p < 0.01) were also reduced. CONCLUSION: A high percentage of spyrometric changes were identified. The majority of the patients are retired due to disability. The patients feel benefit with hydrotherapy, that contributed to reduction of the analgesic and NSAIDs consumption. The importance of the global systemic evaluation and multidisciplinary of the SA to optimize the therapeuthics and improve the quality of life of the patients is pointed out.
- Desempenho de algoritmos de avaliação do risco osteoporótico em mulheres pós-menopáusicas portuguesasPublication . Machado, P; Pereira da Silva, JAOBJECTIVES: Although several algorithms have been proposed to select postmenopausal women PMW for dual-energy x-ray absorptiometry DEXA measurements information on their utility in clinical practice is scarce. Our aim was to assess the utility and the economic repercussion of the use of five of these algorithms in Portuguese postmenopausal women. METHODS: We included 588 PMW and selected five simple algorithms ORAI ABONE Body Weight Criterion OSTA and a modified version of OSTA (OST). Sensitivities specificities predictive values areas under the receiver operating characteristic curve (AUROC) and economic estimates were computed. RESULTS: Sensitivities ranged between 71.2%-80.8% and AUROC between 0.611-0.674. In PMW aged > or = 65 years (Y) the use of any of the algorithms would cause extra costs or a residual saving. In PMW aged > or = 55 and < 65Y considering total savings ABONE had the best performance but considering savings per preventable fracture, ORAI assumed the lead, followed by BWC. In the age group > or = 40 and < 55Y, the most profitable option considering total savings would be not doing DEXA to anyone; considering savings per preventable fracture, BWC figures as the most useful. CONCLUSIONS: This study provides evidence for the validity of all the selected tools as useful algorithms to select PMW for DEXA. On the basis of our results and considering the importance of simplicity in the applicability of an algorithm we would suggest the following strategy in Portuguese PMW: 1) Aged > or = 65Y: perform DEXA irrespective of other risk factors. 2) Aged < 65Y: perform DEXA if body weight < 70Kg.
- Doença pulmonar intersticial como manifestação isolada de sindrome anti-sintetasePublication . Monteiro, P; Coutinho, M; Machado, P; Garcia, J; Salvador, MJ; Inês, L; Silva, J; Malcata, ABThe authors report a clinical case of a woman who had a 3 years diagnosis of hipersensitivity pneumonitis based on intersticial lung disease whithout other manifestations. The diagnosis of antisynthetase syndrome was made three years after the initial symptoms upon the onset of systemic manifestations with articular involvement, myositis and determination of anti-PL 7 antibodies. In this syndrome, the isolated pulmonary involvement is rare.
- Increased prevalence of allergic sensitisation in rheumatoid arthritis patients treated with anti-TNFalphaPublication . Machado, P; Santos, A; Pereira, C; Loureiro, C; Silva, J; Chieira, C; Malcata, ABINTRODUCTION: Tumour necrosis factor alpha (TNFalpha) has emerged as a therapeutic target in chronic inflammatory disorders characterised by a Th1 type immune response, such as rheumatoid arthritis (RA). The presence of allergic disease in these patients could be influenced both by the presence of RA and anti-TNFalpha therapy. Our aim was to evaluate the prevalence of sensitisation to airborne allergens and allergic disease in RA patients, with and without anti-TNFalpha treatment. METHODS: RA patients with (N=20) and without (N=20) anti-TNFalpha therapy (groups T and R) were enrolled. Healthy controls (N=60, group C) were randomly selected from the general population. All participants answered a standardised questionnaire to assess the prevalence of allergic disease and had skin prick tests (SPT) with a standard panel of airborne allergen extracts. RESULTS: Significant differences were found in the prevalence of positive SPT between groups T and R (70% vs 35%, p=0.027) and groups T and C (70% vs 36.7%, p=0.009), but not between groups R and C. The prevalence of allergic disease was similar in the three groups. Groups T and R had similar gender and age distribution, disease duration, disease activity score (DAS28), erythrocyte sedimentation rate and serum C-reactive protein. CONCLUSIONS: Increased prevalence of sensitisation to airborne allergens in RA patients treated with anti-TNFalpha was found. The clinical impact of the positive SPT following anti-TNFalpha initiation has now to be assessed.
- Multinational evidence-based recommendations on how to investigate and follow-up undifferentiated peripheral inflammatory arthritis: integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E InitiativePublication . Machado, P; Castrejon, I; Katchamart, W; Koevoets, R; Kuriya, B; Schoels, MOBJECTIVE: To develop evidence-based recommendations on how to investigate and follow-up undifferentiated peripheral inflammatory arthritis (UPIA). METHODS: 697 rheumatologists from 17 countries participated in the 3E (Evidence, Expertise, Exchange) Initiative of 2008-9 consisting of three separate rounds of discussions and modified Delphi votes. In the first round 10 clinical questions were selected. A bibliographic team systematically searched Medline, Embase, the Cochrane Library and ACR/EULAR 2007-2008 meeting abstracts. Relevant articles were reviewed for quality assessment, data extraction and synthesis. In the second round each country elaborated a set of national recommendations. Finally, multinational recommendations were formulated and agreement among the participants and the potential impact on their clinical practice was assessed. RESULTS: A total of 39,756 references were identified, of which 250 were systematically reviewed. Ten multinational key recommendations about the investigation and follow-up of UPIA were formulated. One recommendation addressed differential diagnosis and investigations prior to establishing the operational diagnosis of UPIA, seven recommendations related to the diagnostic and prognostic value of clinical and laboratory assessments in established UPIA (history and physical examination, acute phase reactants, autoantibodies, radiographs, MRI and ultrasound, genetic markers and synovial biopsy), one recommendation highlighted predictors of persistence (chronicity) and the final recommendation addressed monitoring of clinical disease activity in UPIA. CONCLUSIONS: Ten recommendations on how to investigate and follow-up UPIA in the clinical setting were developed. They are evidence-based and supported by a large panel of rheumatologists, thus enhancing their validity and practical use.
- Multinational evidence-based recommendations on how to investigate and follow-up undifferentiated peripheral inflammatory arthritis: integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E InitiativePublication . Machado, P; Castrejon, I; Katchamart, W; Koevoets, R; Kuriya, B; Schoels, M; Silva-Fernández, L; Canhão, H; Carmona, LOBJECTIVE: /st> To develop evidence-based recommendations on how to investigate and follow-up undifferentiated peripheral inflammatory arthritis (UPIA). METHODS: /st> 697 rheumatologists from 17 countries participated in the 3E (Evidence, Expertise, Exchange) Initiative of 2008-9 consisting of three separate rounds of discussions and modified Delphi votes. In the first round 10 clinical questions were selected. A bibliographic team systematically searched Medline, Embase, the Cochrane Library and ACR/EULAR 2007-2008 meeting abstracts. Relevant articles were reviewed for quality assessment, data extraction and synthesis. In the second round each country elaborated a set of national recommendations. Finally, multinational recommendations were formulated and agreement among the participants and the potential impact on their clinical practice was assessed. RESULTS: /st> A total of 39 756 references were identified, of which 250 were systematically reviewed. Ten multinational key recommendations about the investigation and follow-up of UPIA were formulated. One recommendation addressed differential diagnosis and investigations prior to establishing the operational diagnosis of UPIA, seven recommendations related to the diagnostic and prognostic value of clinical and laboratory assessments in established UPIA (history and physical examination, acute phase reactants, autoantibodies, radiographs, MRI and ultrasound, genetic markers and synovial biopsy), one recommendation highlighted predictors of persistence (chronicity) and the final recommendation addressed monitoring of clinical disease activity in UPIA. CONCLUSIONS: /st> Ten recommendations on how to investigate and follow-up UPIA in the clinical setting were developed. They are evidence-based and supported by a large panel of rheumatologists, thus enhancing their validity and practical use.
- Recomendações Portuguesas para utilização de Metotrexato no tratamento de doenças reumáticasPublication . Canhão, H; Santos, MJ; Costa, L; Bogas, M; Mourão, AF; Machado, P; Fonseca, JE; Pereira da Silva, JAOBJECTIVES: To develop Portuguese evidence-based recommendations for the use of methotrexate (MTX) in daily clinical practice in rheumatic disorders. METHODS: The Portuguese project was integrated in the multinational 3E Initiative (Evidence, Expertise, Exchange) 2007-2008 where a total of 751 rheumatologists from 17 countries have participated. Ten clinical questions concerning the use of MTX in rheumatic diseases were formulated and the Portuguese group added three more questions. A systematic literature search in Medline, Embase, Cochrane Library and 2005-2007 ACR/EULAR meeting abstracts was conducted. Selected articles were systematically reviewed and the evidence was appraised according to the Oxford Levels of Evidence. In Portugal, a national meeting was held in Obidos on February 15th and 16th, 2008, involving 50 rheumatologists who discussed and voted by Dephi method the recommendations. Finally, the agreement among the rheumatologists and the potential impact on their clinical practice was assessed. RESULTS: Thirteen national key recommendations on the use of MTX were formulated: work-up before starting MTX, optimal dosage and route of administration, use of folic acid, monitoring, management of hepatotoxicity, long-term safety, mono versus combination therapy, management in the peri-operative period, during infections, before/during pregnancy and after clinical remission, screening and treatment of tuberculosis and the role of MTX as a steroid-sparing agent in rheumatic diseases. DISCUSSION: The Portuguese recommendations for the use of MTX in daily clinical practice were developed, which are evidence-based and supported by a panel of 50 rheumatologists, enhancing their validity and practical use. This project was integrated in a multinational initiative that led to the recent publication of ten multinational recommendations which differ from ours in some specific aspects.