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Resumo Introdução Alterações na composição corporal do idoso podem ser rapidamente identificadas por profissionais de saúde na Atenção Básica, reduzindo o impacto sobre a saúde, o estado nutricional e a capacidade funcional. Objetivo Identificar relações entre massa e força muscular com o estado nutricional e a capacidade funcional em idosos da comunidade. Método Estudo transversal, envolvendo 323 idosos. A avaliação da composição corporal foi realizada por absorciometria (DEXA) e antropometria. A capacidade funcional foi avaliada pelas Atividades Instrumentais de Vida Diária, pela velocidade da marcha (VM) e Time Up and Go (TUG). Resultados Nesta amostra, o índice de massa magra (IMM) se mostrou associado aos indicadores do estado nutricional (IMC, CP e CC), além de ter apresentado importante correlação com a força de preensão palmar (FPP). A FPP esteve relacionada à VM e ao TUG. A análise de regressão identificou associação entre o IMC e o IMM (p

The Spanish version of the Educational Needs Assessment Tool (SpENAT), is a self-completed questionnaire that assesses the educational needs (ENs) in osteoarthritis (OA) patients, with the purpose of providing tailored and patient-centered information. This study established the sources of information that patients use and to evaluate the ENs of patients with knee osteoarthritis (KOA) using the SpENAT.

El Educational Needs Assessment Tool-versión española (SpENAT) es un cuestionario que evalúa las necesidades educativas (NE) de pacientes. Este estudio estableció las fuentes de información que los pacientes utilizan y evalúa las NE de pacientes con OA de rodilla utilizando el SpENAT.

Resumo Objetivo Este estudo teve o objetivo de analisar a associação entre a osteoartrite (OA) de joelho e a síndrome metabólica (SM) em pacientes idosos não institucionalizados. Métodos Pesquisa transversal, aleatorizada, extraída de um estudo probabilístico por conglomerado realizado com 416 idosos de uma Unidade de Saúde da Família do nosso município. A SM foi definida de acordo com o National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III), e a OA de acordo com a escala Kellgren-Lawrence (KL) (≥ 2). Resultados Para a análise estatística, foi realizada uma análise exploratória de dados, testes de Mann-Whitney ou Qui-quadrado e regressões logísticas uni e multivariadas, com nível de significância de p Conclusão Conclui-se que a OA de joelho associa-se à CC, independente do peso, e que o aumento em sua medida reflete em uma maior chance de SM em idosos não institucionalizados.

BACKGROUND: This study aimed to investigate the relationship between radiologic severity by the grades of the Kellgren-Lawrence scale (K&Ls) independently and in two groups (grades "0 and 1" and "2 to 4") and instruments that assess depression symptoms, cognitive loss, risk of fall and quality of life related to knee osteoarthritis. METHODS: The analyzed materials were derived from a database and collected between 2013-2014 in Amparo (São Paulo, Brazil). 181 elderly with knee osteoarthritis who had a radiologic exam were evaluated for depressive symptoms, cognitive loss, quality of life and risk of fall by: Geriatric Depression Scale (GDS), Mini Mental State Examination (MMSE), WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), Timed Up and Go test (TUG) and Berg Balance Scale (BBS). To statistical analyses was used Fisher's exact test, Mann-Whitney test, Kruskal-Wallis test and Spearman's coefficient. RESULTS: There was no significant relationship between the instruments investigated and the grades assessed individually. However, when assessed by groups, grades “2 to 4” had the worst WOMAC score, the highest frequency and the worst risk of fall in the BBS, but not in the TUG. For GDS and MMSE, no significant relationships were found. In addition, K&Ls was correlated with the WOMAC socre, with no differences between their domains. CONCLUSION: Only when evaluated in groups, the radiological scores of the Kellgren-Lawrence scale pointed to a worse status in the WOMAC and BBS and the WOMAC score accompanies the increase in the radiological grade.

BackgroundThis study aimed to investigate the relationship between radiological severity, as assessed by the individual grades and grouped grades (grades “0 and 1” and “2 to 4”) of the Kellgren-Lawrence scale (K&Ls), and depression symptoms, cognitive loss, risk of falls, and quality of life in relation to knee osteoarthritis, as assessed by other instruments.MethodsData recorded between 2013 and 2014 in Amparo (São Paulo, Brazil) were retrieved for analysis. A total of 181 elderly patients who had knee osteoarthritis and underwent a radiologic exam were evaluated for depressive symptoms, cognitive loss, quality of life, and risk of falls by the Geriatric Depression Scale (GDS), Mini-Mental State Examination (MMSE), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), timed up and go test (TUG), and Berg balance scale (BBS). For statistical analyses, Fisher’s exact test, Mann-Whitney test, Kruskal-Wallis test, and Spearman’s coefficient analysis were used.ResultsThere was no significant relationship between the scores of the instruments investigated and the individual K&Ls grades. However, when the K&Ls scores were assessed by groups, grades “2 to 4” were associated with the worst WOMAC score and the highest frequency and risk of falls according to the BBS but not according to TUG. For the GDS and MMSE, no significant relationships with the K&Ls grades were found. In addition, the K&Ls grade was correlated with the WOMAC score, regardless of the domain.ConclusionThe radiological scores of the Kellgren-Lawrence (K&L) scale were associated with poorer WOMAC and BBS scores only when the K&Ls scores were evaluated in groups, and the WOMAC score was associated with an increase in the radiological grade.

Additional file 3. Comparative analysis between the WOMAC domains and the groups of Kellgren-Lawrence grades.

Additional file 2. Comparative analysis between the WOMAC domains and the grades of the Kellgre-Lawrence.

Additional file 4. Analysis of correlation between the WOMAC domains and the grades of the Kellgren-Lawrence.

Additional file 1. Comparative analysis between groups and categorical variables.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. BACKGROUND: Latin America is a heterogeneous region made up of different populations, cultures, latitudes, altitudes, and immigrants from different areas and ethnic groups. OBJECTIVE: The purpose of this study is to describe the clinical and demographic profile of patients with osteoarthritis (OA) evaluated by a selected group of rheumatologists in 13 Latin American countries. METHODS: A descriptive, observational, cross-sectional study was conducted in 13 Latin American countries of patients with symptomatic OA. Data were collected over a 3-month period using an ad hoc questionnaire to evaluate the clinical and demographic features of OA seen by rheumatologists. RESULTS: Among the 3040 patients, their average age was 62.5 years, and female-to-male ratio was 4.8:1. Patients with body mass index of greater than 30 kg/m or obesity was found in 38.2%. Approximately 88% had primary OA. Joints with OA were as follows: knee 31.2%, hand 9.5%, hand and knee 22.9%, proximal and distal interphalangeal joints (erosive OA) 6.5%, axial 6.6%, and hip 1.3%. Approximately 88.5% had radiographic severity of grade 2 or 3 on Kellgren-Lawrence scale (0-4). Nonsteroidal anti-inflammatory drugs were the predominant OA treatment included in combinations with glucosamine sulfate/chondroitin and viscosupplementation. Associated comorbidities included hypertension (39%), obesity (36.3%), diabetes mellitus (12%), and without comorbidity (12.7%). CONCLUSIONS: This is 1 of the largest population studies that evaluated the characteristics of OA in 3040 patients evaluated by rheumatologists in 13 Latin American countries. This study provides important data for each Latin American country to develop new health care planning in management of OA. Revisión por pares

Aim To describe the main causes and factors associated with mortality in community-dwelling older adults in a county where the public health system covers most of the population. Methods We analyzed data from an existing cross-sectional study of 2209 participants (age ≥60 years) in a city in southeast Brazil where 92% of the population is served by a public system of primary care. Over a period of 7 years, 386 participants died and were included in the sample. We assessed the impacts that dependence on others for basic activities of daily living and instrumental activities of daily living, Geriatric Depression Scale scores, and health history have on mortality. Results The participants' mean age was 75.2 years (SD 8.2); 51.7% of the participants were women, and 51.3% had depressive symptoms. The main causes of death were circulatory diseases (40.3%), cancer (19.8%) and respiratory diseases (13.5%). Multivariate analysis showed that, taken together, the use of more than four medications per day, smoking, lower income, older age and dependence on others for a greater number of instrumental activities of daily living predicted death in this population. Conclusions Understanding the factors that are associated with mortality can facilitate understanding, and aid in developing policies regarding primary care for the elderly. Geriatr Gerontol Int 2015; ●●: ●●–●●.

Background This consensus derives from a previous study of Demographic and Clinical Characteristics by the PANLAR OA study group, reporting significant differences in handling these patients and in which it was evident the need of reaching an agreement in the management of hand, hip and knee OA in Latin America (2) Objectives The aim is to update the recommendations for the treatment of hand, hip and knee OA by agreeing on key propositions relating to the management of hand, hip and knee OA,identifying and critically appraising research evidence for the effectiveness of the treatments and by generating recommendations based on the available evidence and expert opinion. Methods Recommendations were developed by a group of 40 specialists made up of rheumatologists and members of other medical disciplines. A systematic review of articles, meta-analyses and guidelines for the management of hand, hip and knee OA published from 2008 and January 2014 was done. The level of evidence and strength of recommendation were classified according to the Jadad scale (3).The level of agreement was established through a Delphi technique. Results Both “strong” and “conditional” recommendations are given for management of hand, hip and knee OA and non-pharmacological, pharmacological and surgical modalities of treatment are presented according to the different levels of agreement. Conclusions These recommendations are based on the consensus of clinical experts from a wide range of disciplines considering the available evidence, while balancing the benefits and risks of non-pharmacological, pharmacological and surgical treatment modalities. It is hoped that these recommendations will be utilized by healthcare providers involved in the management of patients with hand, hip and knee OA. References Reginato, Anthony M. et al. Osteoarthritis in Latin America: Study of Demographic and Clinical Characteristics in 3040 Patients. JCR: Journal of Clinical Rheumatology 21.8(2015):391–397. Jadad, A.R.; Moore R.A.; Carroll D.; Jenkinson C.; Reynolds D.J.M.; Gavaghan D.J.; McQuay H.J.(1996). Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Controlled Clinical Trials 17:1–12. doi: 10.1016/0197-2456(95)00134-4. PMID 8721797. Disclosure of Interest None declared

Adhesion, proliferation and differentiation of dental pulp stem cells (DPSCs) into chondrocytes were investigated in this work with the purpose of broadening the array of cell alternatives to the therapy of cartilage lesions related to tissue engineering approaches. A porous chitosan-xanthan (C-X) matrix was used as scaffold and kartogenin was used as a selective chondrogenic differentiation promoter. The scaffold was characterized regarding aspect and surface morphology, absorption and stability in culture medium, thickness, porosity, thermogravimetric behavior, X-ray diffraction, mechanical properties and indirect cytocompatibility. The behavior of DPSCs cultured on the scaffold was evaluated by scanning electron microscopy and cell differentiation, by histological analysis. A sufficiently stable amorphous scaffold with mean thickness of 0.89±0.01mm and high culture medium absorption capacity (13.20±1.88g/g) was obtained, and kartogenin concentrations as low as 100nmol/L were sufficient to efficiently induce DPSCs differentiation into chondrocytes, showing that the strategy proposed may be a straightforward and effective approach for tissue engineering aiming at the therapy of cartilage lesions.

Aim In the elderly population, rheumatic conditions are major causes of pain that restrict participation in activities and mobility, and cause difficulties in the execution of self-care tasks. The present study aimed to analyze the prevalence and factors associated with the self-reported rheumatic diseases and chronic joint symptoms of the elderly. Methods This transversal epidemiological survey involved 2209 older adults (aged ≥60 years). The investigation included sociodemographic factors, anthropometrics, activities of daily living, chronic conditions, medication and quality of life. Univariate and multivariate regression analysis were used for statistical procedures, P ≤ 0.05. Results The prevalence of rheumatism was 22.7%. Multivariate analysis showed that rheumatism was correlated with the following: female sex (OR = 1.91), high income (OR = 2.34), cardiovascular disease (OR = 1.42), cataracts (OR = 1.39), glucocorticoids (OR = 5.24), other anti-inflammatory medications (OR = 2.24) and pain (OR = 0.983). After adjusting for age and glucocorticoids, an association between cataracts and rheumatism was detected (OR = 1.32). The prevalence of symptoms was 45.6%. Multivariate regression results for symptoms included the following: female sex (OR = 1.40), body mass index ≥30.0 kg/m2 (OR = 3.31), functional capacity (OR = 0.990), general health (OR = 0.993) and pain (OR = 0.981). After adjustment for age and glucocorticoids, an association between cataracts and symptoms was detected (OR = 1.26). Conclusion There was a significant association of rheumatism and symptoms with women and high incomes. Obesity was associated with joint symptoms, which in turn were associated with an impaired quality of life. Cataracts and cardiovascular disease were associated with rheumatism. The identification of these characteristics in the elderly will contribute to a better understanding of this systemic disease and should be used to plan effective preventive measures. Geriatr Gerontol Int 2013; 13: 1043–1050.

The objective of this consensus is to update the recommendations for the treatment of hand, hip, and knee osteoarthritis (OA) by agreeing on key propositions relating to the management of hand, hip, and knee OA, by identifying and critically appraising research evidence for the effectiveness of the treatments and by generating recommendations based on a combination of the available evidence and expert opinion of 18 countries of America.Recommendations were developed by a group of 48 specialists of rheumatologists, members of other medical disciplines (orthopedics and physiatrists), and three patients, one for each location of OA. A systematic review of existing articles, meta-analyses, and guidelines for the management of hand, hip, and knee OA published between 2008 and January 2014 was undertaken. The scores for Level of Evidence and Grade of Recommendation were proposed and fully consented within the committee based on The American Heart Association Evidence-Based Scoring System. The level of agreement was established through a variation of Delphi technique.Both "strong" and "conditional" recommendations are given for management of hand, hip, and knee OA and nonpharmacological, pharmacological, and surgical modalities of treatment are presented according to the different levels of agreement.These recommendations are based on the consensus of clinical experts from a wide range of disciplines taking available evidence into account while balancing the benefits and risks of nonpharmacological, pharmacological, and surgical treatment modalities, and incorporating their preferences and values. Different backgrounds in terms of patient education or drug availability in different countries were not evaluated but will be important.

Musculoskeletal disorders are the major causes of the pain in the elderly population. Rheumatic conditions restrict participation in activities and mobility, as well as cause difficulties in the execution of self-care tasks. The assessment of health related quality of life (HRQOL) is an important indicator of the impact of rheumatic diseases on the physical, mental and social aspects. This study aims to analyze the influence of rheumatic diseases and chronic joint symptoms on the quality of life of the elderly (n=2209) aged 60 years or over. The effects of rheumatism and joint symptoms on quality of life were investigated by the Outcome Study Short-Form Health Survey (SF-36), and this analysis was adjusted for age and sex. The univariate analysis of variance and analysis of covariance (ANOVA and ANCOVAS) were used for statistical procedures, p≤0.05. Rheumatic diseases affected: functional capacity (F(1, 2012))=10.9 and pain (F(1, 2012))=34.77. Joint symptoms affected all components of the SF-36: physical functioning (F(1, 2012))=10.9; physical problems (F(1, 2012))=72.61; pain (F(1, 2012))=164.29; general health (F(1, 2012))=71.95; vitality (F(1, 2012))=55.78; social aspect (F(1, 2012))=73.14; emotional aspect (F(1, 2012))=49.09 and mental health (F(1, 2012))=44.72. There was a significant impact of rheumatic diseases on physical health, and that joint symptoms affected self-evaluations of physical and mental health. These results will contribute to a better understanding of this systemic disease and will be used for planning effective interventions.

Umbilical cord blood contains undifferentiated mesenchymal stem cells (MSCs) with chondrogenic potential that may be used for the repair of joint damage. The role of growth factors during the process of chondrogenesis is still not entirely understood. The objective of this study was to evaluate the formation of chondrocytes, cartilaginous matrix and type II collagen from human umbilical cord blood stem cells exposed to two different growth factors, BMP-6 and BMP-2, while being cultured as a micromass or a monolayer. Umbilical cord blood was obtained from full-term deliveries, and then, mononuclear cells were separated and cultured for expansion. Afterward, these cells were evaluated by flow cytometry using antibodies specific for MSCs and induced to chondrogenic differentiation in micromass and monolayer cultures supplemented with BMP-2 and BMP-6. Cellular phenotype was evaluated after 7, 14 and 21 days by RT-PCR and Western blot analysis to identify the type II collagen and aggrecan. The expanded cells displayed surface antigens characteristic of mesenchymal progenitor cells and were negative for hematopoietic differentiation antigens. Type II collagen and aggrecan mRNAs were expressed from day 14 in cells stimulated with BMP-2 or BMP-6. Type II collagen was demonstrated by Western blotting in both groups, and the greatest expression was observed 21 days after the cells were stimulated with BMP-2 cultured in micromass. BMP-2 in micromass culture was more efficient to induce the chondrogenesis.

Elderly caregivers suffer physical and psychological consequences of the act of caring. The objective of this study was to characterize primary caregivers of elderly people in the community and identify the higher impacts of this activity on their life. We interviewed 127 caregivers about sociodemographic characteristics, presence of anxiety/depression (self-reporting questionnaire=SRQ), burden of care (caregiver burden scale=CBS); while their dependents were evaluated using sociodemographic questionnaires, health history, activities of daily living (ADL) scale and geriatric depression scale (GDS-15). The caregivers' mean age was 55.1+/-13.3 years; among them most were women and daughters with up to 4 years of education. The mean time as responsible for the elderly was 86.5+/-96.3 months; 56% divided the caring responsibility and 28.2% had another occupation; 32.3% presented psychoemotional illness. There was a positive correlation between the CBS and the caregiver factors: psychoemotional disorders, time as responsible for the elderly and education level; as well as between the CBS and the elderly: number of activities with dependence, presence of depression and incontinences. The correlation between the elderly's personal income and number of visits received was negative. The identification of high impacts on the caregivers' life would facilitate the professional approach.

Objective.Mature articular cartilage is vulnerable to injuries and disease processes that cause irreversible tissue damage because of its limited capacity for self-repair. Umbilical cord blood is a source of mesenchymal stem cells, which can give rise to cells of different lineages, including cartilage, bone, and fat. Cellular condensation is a required step in the initiation of mesenchymal chondrogenesis. We attempted to differentiate cells from umbilical cord blood into chondrocytes with insulin-like growth factor 1 (IGF-1) and transforming growth factor-ß3 (TGF-ß3).Methods.Cells were grown in high density micromass and monolayer culture systems and then evaluated for expression of type II collagen, aggrecan, and Sox9. Umbilical cord blood from 130 patients was harvested.Results.Expression of type II collagen, aggrecan, and Sox9 was detected after 14 days in TGF-ß3- and IGF-1-stimulated cells in both types of culture (monolayer and micromass). On Day 21 in the micromass culture, expression levels were greater than they were at 14 days for all genes. TGF-ß3 was found to be more efficient at promoting chondrogenesis than IGF-1. By western blot, we also found that after 3 weeks, the expression of type II collagen was greater in micromass culture with TGF-ß3.Conclusion.TGF-ß3 used in micromass culture is the best growth factor for promoting the proliferation and differentiation of mesenchymal cells from umbilical cord blood during chondrogenesis. This approach may provide an alternative to autologous grafting.

A 43-year-old woman reported pain in the right hypochondrium, which had started 3 years before and had been worsening for the past few days. Claudication in the superior and inferior limbs, diffuse myalgia, dyspnea, precordialgia followed by dizziness and visual turbidity were added to the clinical picture. In the physical examination bilateral carotid bruit was observed, abdominal aorta murmur and the decrease of the right radial and left pedis pulses and arterial hypertension with difference in the diastolic pressure between limbs >10 mmHg was also observed. On cardiac catheterisation with aortography, right coronary with proximal parietal irregularities, slight pressure increase in right chambers and pulmonary artery, preserved left ventricle contractility, competent valves, carotid and subclavian partial obstruction, severe narrowing of the abdominal aorta below the diaphragm (80%) and right renal artery significant stenosis were observed. Takayasu’s arteritis (TA) diagnosis was established according to the ACR criteria based on the clinical symptomatology, on physical and image test findings. Two years later she presented malar rash, photosensitivity, nephropathy, leukopenia, lymphopenia and hemolytic anemia confirming the systemic lupus erythematosus (SLE) diagnosis. TA coexisting with SLE has rarely been reported.

AIM: To determine whether elderly subjects with distinct histories of falls presented differences concerning the influence of sensory interaction on balance. METHODS: Cross-sectional research. Ninety-six community-dwelling elderly subjects were divided into three groups, according to the history of falls within the past year (group 1, no falls; group 2, one fall; and group 3, recurrent falls). The Clinical Test of Sensory Interaction and Balance was used to evaluate the influence of sensory inputs on standing balance. The test required the subject to maintain stability during 30 s, under six conditions: (i) firm surface with eyes open; (ii) firm surface with eyes closed; (iii) firm surface with visual conflict; (iv) unstable surface with eyes open; (v) unstable surface with eyes closed; and (vi) unstable surface with visual conflict. The time expended on conditions and the number of abnormal cases were compared between groups. Each group was evaluated in relation to its performance in the progression of conditions. RESULTS: More abnormal cases occurred in group 3 compared to group 1 for conditions (iv) and (v); and compared to group 2 for condition (iv). Group 3 remained less time than group 1 under conditions (iv), (v) and (vi). Groups 1, 2 and 3 presented relevant decrements in trial duration from conditions (iv) to (v). For group 3, a significant decay was also noted from condition (i) to (ii). CONCLUSION: Sensorial interaction in the elderly varies according to their history of falls. Thus, it is possible to correctly guide the rehabilitation process and to prevent sensorial decays according to an individual's history of falls. Language: en

To describe the main causes and factors associated with mortality in community-dwelling older adults in a county where the public health system covers most of the population.We analyzed data from an existing cross-sectional study of 2209 participants (age ≥60 years) in a city in southeast Brazil where 92% of the population is served by a public system of primary care. Over a period of 7 years, 386 participants died and were included in the sample. We assessed the impacts that dependence on others for basic activities of daily living and instrumental activities of daily living, Geriatric Depression Scale scores, and health history have on mortality.The participants' mean age was 75.2 years (SD 8.2); 51.7% of the participants were women, and 51.3% had depressive symptoms. The main causes of death were circulatory diseases (40.3%), cancer (19.8%) and respiratory diseases (13.5%). Multivariate analysis showed that, taken together, the use of more than four medications per day, smoking, lower income, older age and dependence on others for a greater number of instrumental activities of daily living predicted death in this population.Understanding the factors that are associated with mortality can facilitate understanding, and aid in developing policies regarding primary care for the elderly. Geriatr Gerontol Int 2016; 16: 804-809.

Camurati-Engelmann disease is a rare bone disorder characterized by cortical thickening of the diaphysis of tubular bones, with sparing of the epiphysis. It has variable degrees of penetrance and expression, but may be very disabling for the affected individuals who manifest the painful symptoms. The authors report on two women with typical presentation of severe Camurati-Engelmann disease whose treatment with bisphosphonates failed to add any improvement beyond that elicited by corticosteroids alone.

DESCRIÇÃO DO MÉTODO DE COLETA DE EVIDÊNCIAS: Foram utilizados os estudos disponíveis na literatura médica presentes nas seguintes bases de dados, acessíveis através da internet: OVID (EBM-Reviews, incluindo-se as bases de dados da Cochrane) e o Medline, de 1966 até o presente, através do Pubmed. Foram selecionados trabalhos de meta-análise e estudos duplo-cegos randomizados, quando presentes. Relatos ou série de casos foram utilizados quando publicados em jornaisde reconhecida idoneidade. As opiniões dos especialistas presentes foram utilizadas em relação a terapias não disponíveis na literatura e que fossem consideradas pela unanimidade dos presentes como importante para o manejo dos pacientes com osteoartrite. Envio prévio da bibliografia principal aos participantes. Reunião para elaboração do documento. Colocação do rascunho na internet por dez dias para mudanças. Elaboração final do documento. GRAU DE RECOMENDAÇÃO E FORÇA DE EVIDÊNCIA: A: Estudos experimentais e observacionais de melhor consistência. B: Estudos experimentais e observacionais de menor consistência. C: Relatos de casos (estudos não controlados). D: Opinião desprovida de avaliação crítica, baseada em consensos, estudos fisiológicos ou modelos animais. OBJETIVOS: Conciliar informações e condutas referentes ao tratamento da osteoartrite pelas três principais especialidades envolvidas, reumatologia, fisiatria e ortopedia. As condutas consensuais para a maioria dos participantes foram então agrupadas e constam nas recomendações deste documento. CONFLITO DE INTERESSE: Os autores Coimbra IB, Pucinelli MLC, Cavalcanti FS e Maciel FMB, declararam vínculo com a Indústria Farmacêutica.

OBJETIVO: avaliar a incidência de osteoartrite de mãos nos pacientes encaminhados aos ambulatórios de reumatologia do Hospital das Clínicas da Universidade Estadual de Campinas e analisar a possível associação entre osteoartrite (OA) de mãos e o índice de massa corpórea (IMC). MÉTODOS: foram analisados 515 pacientes, calculando-se o IMC e também a idade no momento do diagnóstico (20-80 anos), sexo, cor e o diagnóstico através de regressão logística. RESULTADOS: OA de mãos esteve presente em 15,8% dos diagnósticos reumatológicos, incluindo-se, entre outras, as doenças do tecido conjuntivo e as doenças auto-imunes. Não houve relação estatisticamente significativa entre IMC e OA de mãos na regressão univariada. Entretanto, quando realizado estudo de regressão logística multivariada, verificou-se que a cada 1 kg/m² de aumento do IMC, o risco de OA de mãos aumenta em 5,4%. Observou-se, ainda, que pacientes com sobrepeso apresentam 2,16 vezes mais risco de ter OA de mãos que os com peso considerado normal. Os obesos apresentam esse risco 2,04 vezes maior. CONCLUSÕES: a despeito de a associação entre o IMC e a prevalência da OA de mãos não ter sido significativa, pacientes com IMC > 25 apresentam maior risco de desenvolverem OA de mãos. OBJECTIVE: To evaluate the incidence of hand osteoarthritis (OA) among patients that were referred to the Rheumatology Unit at State University of Campinas and to verify the association between hand OA and bone mass index (BMI). METHODS: We evaluated 515 outpatients, calculating the BMI and registering the age at diagnosis, sex, ethnicity and diagnosis. Logistic regression was also performed. RESULTS: Hands OA was present in 15.8%. There was no relation between BMI and hands OA in the univariated analysis. However, when multivariated logistic regression was performed, we observed 5.4% increase in the risk to develop hands OA per each 1 kg/m² of enhance in the BMI. We also observed that overweight patients showed 2,16 fold more risk than normal subjects to present hands OA. The obese patients showed 2.04 fold more risk than the normal ones. CONCLUSIONS: We concluded that despite the lack of direct association between BMI and the hands OA prevalence, patients with BMI > 25 kg/m² are at higher risk to develop hands OA.

The aim of this paper was to evaluate bone mineral density (BMD) in patients with systemic lupus erythematosus (SLE), to determine the role of corticosteroids and cytotoxic drugs and to assess estrogen effect on BMD in SLE.BMD (DEXA) at lumbar vertebrae (L2-L4) and at femoral neck was performed in 60 pre-menopausal SLE patients and in 64 controls. Estradiol level was measured in all the individuals. Age, age at disease onset, body mass index (BMI), time of disease, disease activity (SLEDAI), prednisone dose at the evaluation, total cumulative and cumulative prednisone dose in the last year and cytotoxic drugs were assessed.The mean plasmatic estradiol was 175.9 pg/ml in patients and 149.9 in controls. BMD was inferior in patients than that in controls (P0.0001). The mean current, cumulative and previous year prednisone doses were, respectively, 19.17 mg/d, 28.78 g and 5.33 g. There was no association between corticosteroids or cytotoxic drug used and low bone mass. The serum concentration of estradiol did not influence the bone mass. The BMI and age at disease onset exhibited an influence on BMD at L2.BMD was significantly lower in SLE patients but not related to CS (Corticosteroids)or other drugs; the estradiol in these patients had no effect on BMD. Low BMI interacting with early onset of disease might influence the probability of loss of bone mass.

Resume Objectif. – Evaluer la DMO (densite minerale osseuse) de patients atteints de lupus systemique (SLE), avec une attention particuliere sur la corticotherapie, les traitements immunosuppresseurs et les taux d'œstrogenes. Patients et methodes. – La DMO a ete mesuree par absorptiometrie bi-photonique au rachis lombaire (L2–L4) et au col femoral chez 60 femmes lupiques en pre-menopause et chez 64 volontaires saines. Les taux d'œstradiol ont ete mesures. L'âge au moment de l'etude, l'âge au debut de la maladie, l'index de masse corporelle (BMI), la duree d'evolution de la maladie, l'activite de la maladie (index d'activite de la maladie lupique), la dose de corticoides au moment de l'evaluation, la dose cumulative de corticoides et la corticotherapie de la derniere annee, les immunosuppresseurs ont ete notes. Resultats. – Le taux d'œstradiol plasmatique etait de 175,9 pg/ml chez les patients et 149,9 pg/ml dans le groupe controle. La DMO etait plus basse chez les patientes que dans le groupe controle ( p Conclusions. – La DMO etait significativement plus basse chez les patientes atteintes de LEAD mais n'etait pas reliee a l'utilisation de prednisone ou d'immunosuppresseurs. Les taux d'œstradiol n'influencaient pas la DMO de ces femmes en premenopause. Un indice de masse corporelle bas et une maladie ayant debute jeune augmentaient le risque de demineralisation osseuse.

OBJECTIVES: Articular cartilage is vulnerable to injuries and undergoes an irreversible degenerative process. The use of amniotic fluid mesenchymal stromal stem cells for the reconstruction of articular cartilage is a promising therapeutic alternative. The aim of this study was to investigate the chondrogenic potential of amniotic fluid mesenchymal stromal stem cells from human amniotic fluid from second trimester pregnant women in a micromass system (high-density cell culture) with TGF-β3 for 21 days. METHODS: Micromass was performed using amniotic fluid mesenchymal stromal stem cells previously cultured in a monolayer. Chondrocytes from adult human normal cartilage were used as controls. After 21 days, chondrogenic potential was determined by measuring the expression of genes, such as SOX-9, type II collagen and aggrecan, in newly differentiated cells by real-time PCR (qRT-PCR). The production of type II collagen protein was observed by western blotting. Immunohistochemistry analysis was also performed to detect collagen type II and aggrecan. This study was approved by the local ethics committee. RESULTS: SOX-9, aggrecan and type II collagen were expressed in newly differentiated chondrocytes. The expression of SOX-9 was significantly higher in newly differentiated chondrocytes than in adult cartilage. Collagen type II protein was also detected. CONCLUSION: We demonstrate that stem cells from human amniotic fluid are a suitable source for chondrogenesis when cultured in a micromass system. amniotic fluid mesenchymal stromal stem cells are an extremely viable source for clinical applications, and our results suggest the possibility of using human amniotic fluid as a source of mesenchymal stem cells.

Objective To study the changes in patterns of gene expression exhibited by human chondrocytes as they dedifferentiate into fibroblastic cells in culture in order to better understand the mechanisms that control this process and its relationship to the phenotypic changes that occur in chondrocytes during the development of osteoarthritis (OA). Methods Human fetal epiphyseal chondrocytes (HFCs) were cultured either on poly-(2-hydroxyethyl methacrylate)–coated plates (differentiated HFC cultures) or in plastic tissue culture flasks as monolayers (dedifferentiated HFC cultures). Following 11 days of culture under either condition, poly(A+) RNA was isolated from the two cell populations and subjected to a gene expression analysis using a microarray containing ∼5,000 known human genes and ∼3,000 expressed sequence tags (ESTs). Results A ≥2-fold difference in the expression of 62 known genes and 6 ESTs was observed between the two cell types. The differences in expression of several of the genes detected by the microarray hybridization were confirmed by Northern analyses. Two transcription factor genes, TWIST and HIF-1α, and a cellular adhesion protein gene, cadherin 11, were markedly regulated in response to differentiation and dedifferentiation. Expression of these genes was also detected in adult normal and OA cartilage and chondrocytes. Analysis of the gene expression profile of HFCs revealed a complex pattern of gene expression, including many genes not yet reported to be expressed by chondrocytes. Conclusion Chondrocytes in monolayer become dedifferentiated, acquiring a fibroblast-like appearance and changing their pattern of gene expression from one of expression of chondrocyte-specific genes to one that resembles a fibroblastic or chondroprogenitor-like pattern. Changes in gene expression associated with the process of dedifferentiation of HFCs in vitro were observed in a wide variety of genes, including genes encoding extracellular matrix proteins, transcription factors, and growth factors. At least 3 of the genes that were regulated in response to dedifferentiation were also found to be expressed in adult normal and OA articular cartilage and chondrocytes.

Psychosis and swelling of the face and hands are rarely observed in adult polyarteritis nodosa (PAN). We describe a 21-year-old woman who presented with fever, livedo reticularis, tender subcutaneous nodules and arthritis. These manifestations did not respond to prednisone, but remitted when the drug was tapered. She had had psychosis since the age of 16 years. During the flares of the disease she presented with facial, periorbital and hand swelling. This finding is rarely observed in adult PAN. Arteriography showed multiple small aneurysms, of the mesenteric vessels consistent with a diagnosis of PAN. Our report discusses the diagnosis of PAN and emphasises the uncommon presentation of this case.

Background Although recent advances in knee osteoarthritis (OA) treatment and evaluation were achieved, to the best of our knowledge, few studies have evaluated the longitudinal effect of therapeutic modalities on the functional exercise capacity of patients with knee OA. The purpose was to investigate the effects of kinesiotherapy and electrotherapy on functional exercise capacity, evaluated using the six-minute walk test (6-MWT) in patients with bilateral knee OA. Secondary measurements included range of motion (ROM), severity of knee pain (VAS), and a measure of perceived health and physical function, evaluated using the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index. Methods A total of 40 women with bilateral knee OA were assigned to three groups: kinesiotherapy (KIN, n = 16), transcutaneous electrical nerve stimulation (TENS, n = 12), or ultrasound (US, n = 10). The groups underwent 12 weeks of intervention twice per week. The participants were subjected to the 6-MWT, ROM, VAS and WOMAC index. These tests were performed before and after the intervention. The study was focused on outpatients and was carried out at Universidade Estadual de Campinas, Brazil. Results At follow-up, the KIN and US groups had significantly higher 6-MWT distances (19.8 ± 21.7 and 14.1 ± 22.5%, respectively) compared with their respective pre-intervention values. All treatments were effective for reducing pain and improving the WOMAC index. Conclusions We demonstrated that the 6-MWT is a tool that can be used to evaluate improvements in the functional exercise capacity of patients submitted to a clinical intervention.

Os sistemas sensoriais (visual, somato-sensitivo e vestibular) são responsáveis pelo início do processo de construção do equilíbrio corporal humano. No entanto, esses sistemas sofrem alterações causadas pela senescência e pela presença de doenças. Tais modificações no funcionamento sensorial podem predispor o idoso à instabilidade, e, consequentemente, às quedas. O objetivo desta revisão de literatura foi expor os elementos sobre a função dos sistemas sensoriais no equilíbrio corporal dos idosos, dando um panorama geral da ação, avaliação e reabilitação da interação sensorial. Para estes fins, realizou-se revisão bibliográfica narrativa da literatura nacional e internacional sobre o tema, tendo como base textos das bases de dados Medline e Lilacs. De acordo com a literatura, existe uma grande dependência, por parte dos idosos, da informação proprioceptiva e visual para o controle postural. Contudo, nas situações de conflito entre as informações ambientais e corporais, é acionado o sistema vestibular. Entre os testes empregados na avaliação do equilíbrio em condições sensoriais podemos citar: as plataformas de força, eletromiografias, sistemas de fotofilmagens, o teste de Romberg e o Clinical Test of Sensory Interaction and Balance. A reabilitação do equilíbrio sensorial é baseada na exposição do idoso repetidamente às condições de dificuldade. Dentre as técnicas que podem ser empregadas na reabilitação sensorial estão o Tai Chi Chuan, a Reabilitação por Realidade Virtual e a reabilitação vestibular. Com o maior conhecimento da função dos mecanismos sensoriais no envelhecimento, é possível ao profissional da saúde detectar os déficits sensoriais e planejar as estratégias voltadas à reabilitação do equilíbrio a fim de evitar as quedas.

This study aims to determine the factors that may be related to falls in the elderly assisted by the Family Health Program (FHP). Elderly individuals aged 60 years or over, who were assisted by the FHP primary care system (n=2209), responded to a sociodemographic and health questionnaire. Mental health was evaluated using the Geriatric Depression Scale (GDS) and quality of life was assessed by the Medical Outcome Study Short-Form Health Survey (SF-36). In order to verify which independent variables affected the occurrence of falls, logistic regression analysis was performed. 27.1% of the sample reported one fall during the previous year, and 8.7% were recurrent fallers over the same period. The factors considered in the final model for falls were: age over 80 years-old, female gender, the presence of more than eight associated diseases, need for hospitalization during the previous year and appointments outside the FHP routine, hearing complaints, GDS score over 11 points, and emotional problems SF-36 score between 25 and 74 points. The factors included in the final model for falls can be easily identified and properly overcome by FHP strategy. Patient falling history investigation should thus form part of the FHP team routine. This concern should be reinforced when it comes to women aged 80 years and over.

To evaluate disease characteristics of childhood onset SLE in Latin America and to compare this information with an adult population in the same cohort of GLADEL. A protocol was designed as a multicenter, multinational, inception cohort of lupus patients to evaluate demographic, clinical, laboratory and serological variables, as well as classification criteria, disease activity, organ damage and mortality. Descriptive statistics, chi square, Fisher's exact test, Student's t test and multiple logistic regression were used to compare childhood and adult onset SLE. 230 patients were < 18 years and 884 were adult SLE patients. Malar rash, fever, oral ulcers, thrombocytopenia and hemolytic anemia and some neurologic manifestations were more prevalent in children (p < 0.05). On the other hand, myalgias, Sjögren’s syndrome and cranial nerve involvement were more frequently seen in adults (p < 0.05). Afro-Latin-American children had a higher prevalence of fever, thrombocytopenia and hemolytic anemia. White and mestizo children had a higher prevalence of malar rash. Mestizo children had a higher prevalence of cerebrovascular disease and cranial nerve involvement. Children met SLE ACR criteria earlier with higher mean values than adults (p: 0.001). They also had higher disease activity scores (p: 0.01), whereas adults had greater disease damage (p: 0.02). In Latin America, childhood onset SLE seems to be a more severe disease than adults. Some differences can be detected among ethnic groups.

Background Various neurological manifestations have been considered to be important features of Systemic Lupus Erythematosus (SLE) and indicative of Central Nervous System (CNS) involvement. Few studies of SNC include headache and the real prevalence of headache in SLE remain unknown, but some authors consider it one of the most frequent neurological symptoms, especially during acute disease. Objectives To determine the point prevalence and the different types of headache in patients with SLE. To investigate associations between headache and clinical and laboratory manifestation of SLE, corticosteroid therapy, disease activity and CNS involvement. Methods A cross-sectional study of 40 patients with SLE was compared to 40 patients with rheumatoid arthritis (RA) and 40 controls. To assess the different types of headache an especial questionnaire was elaborated, according with ACR case definition. Systemic disease activity was measured by SLEDAI. Statistics were performed by chi-square test and by Fisher’s exact test. Results Headache was observed in 62.5% in SLE compared to 47.5% (p = 0.26) in RA and to 35.1% in controls (p = 0.0247). The types of headaches observed in SLE was migraine in 46%, tension headache in 36% and 20% had headaches during their menses. In RA we observed that 15.7% (p = 0.05) had migraine, 21% had tension headache, 37.5% had headache related to visual problems and 26% had headaches during the menses. In the control people group the prevalence of migraine was 23% (p = 0.05), tension headache 38% and headache during the in 38%. There was no significant association between headache and clinical manifestations of SLE, with laboratory abnormalities or the use of corticotherapy. A significant association in SLE was observed between seizures and migraine (p When comparing the presence of migraine to clinical and laboratorial results we observe a significant association with Raynauds phenomenon (p Conclusion Migraine was more prevalent in SLE than in the control groups. The positive association between migraine and seizures and a higher score at SLEDAI could be related to a greater CNS involvement in these patients. In our study, migraine was associated to antiphospholipid antibodies. References Omdal R, Mellgren SI, Husby G. Clinical neuropsychiatric and neuromuscular manifestations in systemic lupus erythematosus. Scand J Rheumatol. 1988;17:113–17 Adelman DC, Saltiel E, Klinenberg JR. The neuropsychiatric manifestations of systemic lupus erythematosus: an overview. Semin Arthritis Rheum. 1986;15(3):185–99

Background The personnel engaged in physical fitness programmes can suffer from many injuries due to sustained training. 1,2 Musculoskeletal injuries related to exercise are the main cause of premature discharge from military service and temporary disabilities. 2,3 When the risk factors are well-known and identified, prevention strategies can be better targeted and become more effective.4,5 However, there is still a lack of complete knowledge regarding the aetiology of exercise related to musculoskeletal disorders, which makes the establishment of prevention methods empiric for such injuries. 6 Objectives To determine the injury rates related to physical training occurring at a Brazilian military school, to investigate the risk factors for musculoskeletal injuries in general and for the most prevalent musculoskeletal injury observed, and to assess the quality of life of injured participants and the improvement in quality of life after treatment. Methods 498 military students were investigated during an 11-month period and were subjected at the beginning of the military service to evaluations, including physical fitness tests and anthropometric measurements. The variables included in the model were: running test, push-up test, pull-up test, sit-up test, swimming test, height, weight, and body mass index. The injury data were obtained in the physiotherapy service, and a comparison between the injured and uninjured group was conducted. The quality of life of the injured participants was evaluated using the SF-36 questionnaire, which was applied again thirty days after treatment had begun. Results Musculoskeletal injuries were exhibited by 28.31% of the students. Of these injuries, 62.41% were overload injuries. Medial Tibial Stress Syndrome (MTSS) was the most prevalent injury. None of the studied variables represented risk factors for musculoskeletal injuries in general. Lower body mass index and lower weight were found to be risk factors for Medial Tibial Stress Syndrome. The quality of life of the injured participants improved substantially after treatment. Conclusions The studied variables are not risk factors for musculoskeletal injuries in general, while low BMI and low weight are risk factors for MTSS. Physiotherapy treatment does an important role in the quality of life of injured militaries. References Morken T, Mageroy N, Moen BE. Physical activity is associated with a low prevalence of musculoskeletal disorders in the Royal Norwegian Navy: a cross sectional study. BMC Musculoskeletal disorders 2007; 8:56. Mehri NS, Sadeghian M, Tayyebi A, et al. Epidemiology of physical injuries resulted from military training course. Iranian Journal of Military Medicine 2010;12(2):89-92. Taanila H, Hemminki AJM, Suni JH, et al. Low Physical Fitness is a strong predictor of health problems among young men: a follow-up study of 1411 male conscripts. BMC Public Health 2011; 11:590. Murphy DF, Connolly DAJ, Beynnon BD. Risk factors for lower extremity injury. A review of the literature. Br J Sports Med 2003; 37:13-29. Willems TM, Clercq DD, Delbaere K, et al. A prospective study of gait related risk factors for exercise-related lower leg pain. Gait & Posture 2005. Thacker SB, Gilchrist J, Stroup DF, et al. The prevention of shin splints in sports: a systematic review of literature. Med Sci Sports Exerc 2001; 34(1):32-40. Disclosure of Interest None Declared

INTRODUÇÃO e OBJETIVO: A osteoartrite (OA) embora frequente tem patogênese incerta em humanos. Descrevemos modelo experimental original de OA em cães, analisando em dois tempos diferentes as consequências da Ruptura Espontânea do Ligamento Cruzado Cranial (RLCCr). MÉTODOS: Vinte animais machos com menos de 5 anos ( 20 a 45 Kg) com RLCCr submetidos à artrotomia para estabilização articular tiveram fragmentos articulares removidos para análise. O grupo RLCCr < 20 (10 animais) foi operado antes dos vinte dias e o grupo > 20 (10 animais) após 20 dias do início da lesão. Sete animais com OA pré-existente (OA) que morreram por quaisquer motivos e 7 animais normais (NC) provenientes do C.C.Z., serviram de grupos controles. Os animais foram avaliados clinica e radiologicamente. Foi colhido líquido sinovial dos animais operados e de outros 20 cães controles submetidos às cirurgias por diferentes causas. Para estudo morfológico, os fragmentos de cartilagens foram corados com H&E e Picrossirius. A gravidade do escore histológico da OA foi quantificada através da coloração com Safranina O. Analisou-se citocinas próinflamatórias (IL-6, TNF-alfa) e a quimiocina CCL2/MCP-1 nos líquidos sinoviais. RESULTADOS: Todos os cães tinham o teste de movimento da gaveta e exame de compressão da mesa tibial positivos. Achados radiográficos correlacionaram-se com maior tempo de RLCCr. Cartilagem articular de animais normais (NC) exibiram superfície preservada, disposição ordenada dos condrócitos e integridade da rede de colágeno. Exames histológicos em animais do grupo RLCCr < 20 mostraram irregularidades na superfície articular, diminuição no número de condrócitos e remodelamento de fibras de colágeno. No grupo > 20, observou-se osteófitos e irregularidades evidentes nas superfícies articulares. A gravidade do escore de acometimento histológico traduziu-se por intensa diminuição celular na superfície articular, com presença de clusters de condrócitos na região intermediária da cartilagem e total desorganização da rede de fibras de colágeno. A quimiocina CCL2/MCP-1 esteve aumentada no grupo com menos de 20 dias de lesão, enquanto a IL-6 foi mais expressiva nos animais operados tardiamente. CONCLUSÃO: O modelo experimental espontâneo de OA canino, estudado em dois tempos, é um instrumento original e útil para estudo da patogênese da osteoartrite, além de ter o mérito de preservar a integridade física dos animais de laboratório INTRODUCTION and OBJECTIVE: Osteoarthritis (OA) is a frequent and severe rheumatic disease of unknown pathogenesis. We described an original experimental model of OA, analyzing the consequences of spontaneous cranial cruciate ligament rupture (RLCCr), occurred at two different times. METHOD: Twenty male animals, younger than 5 years old (20 to 45kg) with RLCCr were submitted to arthrotomy for articular stability and had cartilage fragments removed for analysis. The Group RLCCR < 20 (10 animals) was operated before 20 days and Group RLCCR > 20 (10 animals) after 20 days of beginning of lesion. Seven animals with pre-existent OA which died without any reason, and 7 normal animals (NC) from Service of Zoonosis Control were the control groups. The animals were submitted to clinical and radiological evaluations. Synovial fluid were collected from operated dogs and from another 20 control animals, submitted for surgical procedures for any reason. For the morphological study, the cartilage fragments were stained with H&E and Picrossirus. The score for OA severity was quantified using Safranin-O staining. Inflammatory cytokines (IL-6 and TNF alfa) and chemiokine CCL2/MCP-1 were measured in sinovial fluid. RESULTS: At physical examination, all the dogs had positive drawer and the tibial plateau compression tests. Knee Radiographic data showed that narrowing of joint space, osteophytes and erosions were more prominent in Group RLCCr> 20 animals. Articular cartilage of normal animals (NC) revealed preserved cartilage surface, organized disposition of chondrocytes and integrity of collagen net. Histological exams done in animals from Group RLLCr > 20 showed irregularities on articular surface, reduction of the number of chondrocytes and collagen fibers remodeling. Animals from Group RLCCR > 20 exhibited deep fibrillations, presence of chondrocytes clusters at intermediate area of cartilage, osteophytes and and total disorganization of the collagen fibers net. Chemiokine CCL2/MCP-1 was found overexpressed in dogs operated less than 20 days, while IL-6 was increased in late surgical group. CONCLUSION: The spontaneous model of canine RLCCr, studied at two distinct times, is an original and useful tool to understand pathogenesis of OA. Furthermore, the procedure preserves the animal integrity, becoming an Ethical laboratorial procedure

Descrevemos modelo original de sinovite experimental em coelhos imunizados com colágeno V com escasso processo inflamatório, intenso remodelamento matricial e vasculite. Analise morfológica e bioquímica foi realizada em coelhas Nova Zelândia (N=20) imunizadas com colágeno do tipo V, comparadas com controles. Foi observado o aumento dos colágenos I, III e V, oclusão do lúmen vascular e escasso processo inflamatório. A análise bioquímica confirmou a fibrose com aumento da síntese de colágeno. Nós postulamos que as alterações sinoviais descritas neste modelo foram conseqüência das particularidades do colágeno V, que promove manifestações imunológicas e clínicas semelhantes à esclerodermia We described an original model of experimental synovitis in rabbits immunized with collagen V with scant cellular infiltration, intense matrix remodeling and vasculitis. Morphological and biochemical analysis were realized in New Zealand female rabbits (N=20) immunization with type V collagen, compared with control rabbits. It was observed increase of collagen I, III and V, vascular lumen occlusion and scant inflammatory process. Biochemical analysis confirmed the fibrosis with increased synthesis of collagen. We postulate that synovial changes described in this model are consequence of collagen V particularities, which promotes immunologic and clinical manifestations similar to scleroderma