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Este trabalho é um estudo epidemiológico que procura estabelecer correlaçöes entre a concentraçäo sérica de ácido úrico e outros fatores, como localizaçäo geográfica, etnia, idade, sexo e obesidade. Foram estudados 958 indivíduos da regiäo da Alta Paulista, no Estado de Säo Paulo, Brasil, submetidos a anamnese, exames clínicos, reumatológico e laboratoriais. Encontraram-se níveis de ácido úrico sérico significantemente mais elevados na populaçäo urbana quando comparados com a populaçäo rural. Nas duas populaçöes, tanto urbana quanto rural, os níveis séricos de ácido úrico foram significantemente mais elevados no grupo masculino que no feminino. Näo houve correlaçäo entre níveis séricos de ácido úrico e idade, embora entre as mulheres se observasse aumento significante da urecemia a partir dos 40 anos. Näo houve diferença quanto à urecemia entre as raças branca e näo branca. Indivíduos obesos apresentaram níveis maiores de urecemia em relaçäo aos näo obesos, embora essa diferença tenha sido estatisticamente significante apenas na amostra de origem urbana. Näo houve correlaçäo entre os níveis séricos de ácido úrico e trigliceridemia, colesterolemia e glicemia

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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.

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OBJECTIVE: To evaluate the sensitivity and specificity of the ESSG criteria when applied to Brazilian patients with SpA and control patients with other rheumatic diseases. METHODS: Seventy patients with spondylarthropathies and 62 patients with other rheumatic diseases were interviewed, examined and had their charts reviewed. The diagnoses of the diseases were based on published diagnostic guidelines or classification criteria. Data were also collected according to the ESSG criteria. RESULTS: The sensitivity and specificity of the ESSG classification criteria were 98.5% and 88.7%, respectively. The sensitivities of the criteria in the different subgroups of SpA ranged from a low of 97.7% in AS to a high of 100% in other SpA studied. CONCLUSION: Despite differences in the socio-cultural and geographic characteristics and in individual disease frequencies, the ESSG preliminary classification criteria performed well when applied to Brazilian patients.

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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.

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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.

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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.

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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).

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O lúpus eritematoso sistêmico (LES) é uma síndrome auto-imune multissistêmica. O acometimento cutâneo é freqüente e constitui manifestaçao clínica importante. O polimorfismo das lesoes cutâneas presume o envolvimento de diversos fatores etiopatogênicos. As células de Langerhans epidérmicas (CLs) têm funçoes imunorregulatórias importantes e participam de um modo decisivo na fisiopatologia de várias doenças dermatológicas inflamatórias, existindo evidência de seu envolvimento da patogênese da lesao cutânea lúpica. O camundongo F1 (NZB x NZW) um dos mais completos modelos experimentais de LES, nao desenvolve lesoes de pele. A ausência de dados na literatura referentes as CLs no camundongo F1 (NZB x NZW) motivou-lhes a realizar o presente estudo, que demonstrou, de forma original, a presença de CLs na epiderme do modelo F1, tanto por técnica citoquímica quanto por microscopia eletrônica de transmissao. Utilizando a técnica citoquímica da ATPase, estudamos as CLs no camundongo F1 (NZB x NZW) antes e após irradiaçao com luz ultravioleta B (UVB). As CLs no modelo F1 apresentaram-se em maior número e com alteraçoes morfológicas (dendritos curtos e menos ramificados) quando comparadas com os animais dos grupos-controles (BALB/c e C57BL/6). A irradiaçao UVB induziu alteraçoes morfológicas e reduçao no número das CLs do camundongo F1 em extensao semelhante ao observado no camundongo BALC/c. Nossos resultados sugerem possível alteraçao funcional nas CLs do camundongo F1 (NZB x NZW) e fornecem evidências de que estas células nao apresentam maior sensibilidade à luz UVB em comparaçao às de outras raças de camundongos. Estudos adicionais sao necessários para se testar possível associaçao entre essas alteraçoes fenotípicas das CLs e a ausência de manifestaçoes cutâneas nos camundongos F1 (NZB x NZW)

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