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In patients with ANCA-associated vasculitis, interactions between neutrophils and endothelial cells cause endothelial damage and imbalance. Endothelial colony-forming cells (ECFCs) represent a cellular population of the endothelial lineage with proliferative capacity and vasoreparative properties. This study aimed to evaluate the angiogenic capacity of ECFCs of patients with granulomatosis with polyangiitis (GPA). The ECFCs of 13 patients with PR3-positive GPA and 14 healthy controls were isolated and characterized using fluorescence-activated cell sorting, capillary tube formation measurement, scratching assays and migration assays with and without plasma stimulation. Furthermore, three patients with active disease underwent post-treatment recollection of ECFCs for longitudinal evaluation. The ECFCs from the patients and controls showed similar capillary structure formation. However, the ECFCs from the patients with inactive GPA exhibited early losses of angiogenic capacity. Impairments in the migration capacities of the ECFCs were also observed in patients with GPA and controls (12th h, p = 0.05). Incubation of ECFCs from patients with GPA in remission with plasma from healthy controls significantly decreased migration capacity (p = 0.0001). Longitudinal analysis revealed that treatment significantly lowered ECFC migration rates. This study revealed that ECFCs from the patients with PR3-positive GPA in remission demonstrated early losses of tube formation and reduced migration capacity compared to those of the healthy controls, suggesting impairment of endothelial function.

Objectives In a longitudinal case–control observational study, we evaluated the benefits of a self-management programme for hands developed for patients with SSc. Methods Patients with SSc included in the intervention group (IG) received a concise self-management programme with emphasis on hand exercises and were evaluated during 24 weeks regarding hand pain, hand function, range of motion, grip and tip and key pinch strength. Results were compared with a control group (CG) with no intervention using an analysis of variance for repeated measures with variables transformed into ranks (P ≤ 0.05). Effect sizes were calculated using Cohen’s test. Results Of 90 patients who were evaluated, seven were excluded at enrolment and 26 were excluded during the follow-up. Data from 57 subjects (IG 40, CG 17) were used for analysis. Groups were similar at baseline, except for the Scleroderma HAQ and tip and key pinch strength. Outcome improvements were noted only in the IG (P ≤ 0.05, large effect size). In the CG, variables did not change or had even worsened (hand grip strength and finger motion). Conclusions This self-management programme based on hand exercises for SSc resulted in pain reduction and hand function, strength and range of motion improvement. It can be a simple and useful intervention, especially when a regular rehabilitation programme is not available.

A 36-year-old man was admitted to the emergency department due to a 30-day history of abdominal distention and epigastralgia. He had described a non-intentional 10kg weight loss, dry cough, and fever 6 months before his admission. He had a history of tobacco and cocaine abuse and reported recurrent oral and genital ulcers. Physical examination showed an extensive area of venous collateral circulation on the abdominal wall, hepatomegaly, signs of a moderate ascites, and lower limb edema. Liver and renal function tests were normal. The ascitic fluid analysis did not show an inflammatory or infectious pattern. Upper flexible endoscopy revealed esophageal fine-caliber varices and colonoscopy showed an isolated terminal ileal ulcer. Abdominal imaging revealed hepatomegaly, voluminous ascites, and thrombosis of hepatic veins, inferior and superior vena cava (Figure 1). Infections and coagulation or lymphoproliferative disorders were excluded. Thereafter, the diagnosis of Budd-Chiari Syndrome in Behçet disease was established and immunosuppression treatment was started with good initial clinical evolution.

Objective Few studies have taken advantage of 18F-fluorodeoxyglucose positron emission tomography associated with computed tomography (18F-FDG PET/CT) to personalize patient evaluation and identify sites of more active disease in Takayasu arteritis (TA)–treated patients. This study aimed to evaluate the utility of 18F-FDG PET/CT in late acquisition in identifying sites of active disease in patients under full treatment for TA. Methods In this cross-sectional study, patients under full treatment underwent whole-body 18F-FDG PET/CT. Sites of increased 18F-FDG uptake were classified by a score of 3 on the visual scale using the liver uptake as reference. A quantitative analysis was also performed by measuring the maximum standardized uptake value (SUV) of the vascular wall of affected arteries. Disease activity using the National Institutes of Health criteria was also evaluated. Results Of the 20 patients, there were 18 female and 2 male patients, with a mean age of 43.6 (±11.58) years and a disease duration of 8.3 (±6.25) years. Thirteen participants (65%) were in inflammatory activity according to the criteria proposed by the National Institutes of Health. All patients received immunosuppressive agents, and one of them received immunobiological treatment. The highest SUV value was 6.2 in the aortic arch, and the lowest was 1.0 in the subclavian artery. The mean maximum SUV did not differ between clinically active and inactive patients. In the visual analysis, all participants had at least 1 vascular site with inflammatory activity, with an uptake ≥2 in relation to the liver. The aortic arch was the most frequently involved site. Conclusions This study showed that 18F-FDG PET/CT in late acquisition is an effective imaging method to assess TA activity even in fully treated patients.

Orientadores: Sandra Regina Muchinechi Fernandes, Sandra Cecilia Botelho Costa Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas Resumo: Poliarterite nodosa (PAN) é uma vasculite sistêmica necrosante de pequenas e médias artérias e a poliangiíte microscópica de pequenos vasos (arteríolas, vênulas e capilares) caracterizada por glomerulonefrite necrosante pauci-imune rapidamente progressiva e envolvimento pulmonar que estão ausente na PAN. Uma possível relação etiológica entre as vasculites sistêmicas e infecção viral tem sido considerada. O vírus da hepatite B está comprovadamente associado à etiopatogênese em alguns casos de PANe outros agentes virais são também apontados como prováveis desencadeadores de PAN, tais como os vírus HIV, HTLV1, citomegalovírus e parvovirus B19 (B19). Na PAN existem relatos de casos comprovando a presença concomitante de atividade da doença e testes sorológicos IgM positivos para o B19 e pela presença do DNA do B19 no soro, medula óssea e músculo em um paciente, pesquisado por reação em cadeia de polimerase (PCR). Não há investigação referente à pesquisa de DNA do parvovírus B19 em amostras teciduais de PANe poliangiíte microscópica. A pesquisa desta associação se toma importante na abordagem terapêutica destas doenças pela necessidade de corticosteróides e imunossupressores podendo agravar as manifestações de uma parvovirose associada. Nosso objetivo foi pesquisar a presença do DNA viral do B19 em tecidos fixados em parafina e com evidência histopatológica de vasculite em pacientes com PANe poliangiíte microscópica e se há relação com as manifestações clínicas, índices de atividade (BVAS) e gravidade (FFS) da doença. Foram investigados todos os pacientes com diagnóstico histopatológico de PAN ou poliangiíte microscópica, com blocos de parafina disponíveis no Departamento de Anatomia Patológica e acompanhados no Ambulatório de Vasculites do Hospital das Clínicas/Disciplina de Reumatologia da FCM!Unicamp no período de 1985 a 2003. A investigação foi feita pela pesquisa da presença de seqüência de ácidos nucléicos do B19 por PCR. Foram encontrados 21 pacientes com amostras teciduais e blocos de parafina disponíveis para estudo. Destas 21 amostras, 17 apresentaram DNA de boa qualidade para realização do PCR para o B19. Dez com diagnóstico de PAN (média da idade 29,3:!::15,1; M:F=I,5:1) e sete de poliangiíte microscópica (média da idade 41,9 :!::18,5; M:F=1:1,3). A média do BVAS, no início da doença, foi de 15,7 :!:: 7,7 com mínimo de 5 e máximo de 26 para PANe de 20,7 :f: 7,1 com mínimo de 13 e máximo de 31 para poliangiíte microscópica. Na PAN, FFS=1 em 60% e FFS=O em 40% dos casos, com média de 0,6 :f: 0,5. Na poliangiíte microscópica FFS=2 em 14%, FFS=1 em 43% e FFS=O também em 43% dos casos, com média de 0,7 :f:0,8. . I Nenhum dos tecidos avaliados apresentou positividade para o DNA do B19. Este resultado sugere que o B19, provavelmente, não está associado a etiopatogenia da PAN idiopática e da poliangiíte microscópica Abstract: Polyarteritis nodosa (PAN) is a well-known form of sistemic necrotizing vasculitis. lndividualized ftom PAN, microscopic polyangiitis (MPA) is a systemic vasculitis of small-sized vessels (arterioles, venules or capillaries) characterized by the presence of rapidly progressive glomerulonephritis and pulmonary involvement, absent in PAN. Nowadays, a role of viral infections in primary systemic vasculitis has been considered. The hepatitis B virus is associated with the ethiopathogenesis ofsome cases ofPAN. HIV, HTLVl, CMV and parvovirus B19 (BI9) may also be found, eventually, in some patients with PAN. Evidence of the B19 involvement in primary systemic vasculitis is based on some anedoctal reports of cases of Wegener' s granulomatosis and PAN and studies with giant-cell arteritis. Regarding in PAN, there are few reports showing an active disease and positive serological tests for the B19. B19DNA is the serum, marrow bone and muscle was found in one patient with PAN. To our knowledgment, there is no research related to B19DNA in tissue samples of patients with PAN and MPA Our objective was to identify the presence ofB19 DNA in fixed, paraffin-embedded tissue samples obtained ftom patients with PAN and MPA We investigated the patients with histological diagnosis of PAN or MPA who were attended at the university hospital ftom 1985 to 2003. AlI fixed, paraffin-embedded tissue samples available, with evidence of vasculitis, were screened for B19 DNA using the polymerase chain reaction (PCR) method. ,Among all patients, we found 17 tissue samples available for the study. Ten had PAN (mea nage 29.3 :t: 15.1yrs.; M:F sex ratio 1.5:1)and seven had microscopicpolyangiitis (mean age 41.9 :t: 18.5 yrs.; M:F sex ratio 1:1,3). AlI of the patients investigatedwere negative for parvovirus B19 DNA .J These results suggest that the parvovirus B19 is not involved in the pathogenesis of idiopathic PAN and MPA Mestrado Clínica Médica Mestre em Clínica Médica

BACKGROUND Endothelial progenitor cells are essential for vascular homeostasis. Considering the recurrent nature of granulomatosis with polyangiitis (GPA) the aim of the study was to evaluate the angiogenic capacity of endothelial colony-forming cells (ECFC), which have the capacity for neovasculogenesis in vitro, of the patients with GPA, before and after plasma stimulation. METHODS Thirteen GPA PR3-positive patients and 15 healthy controls were included. ECFC were isolated from periferic blood and characterized by flow cytometry (FACS). Capillary tube formation (Matrigel assay) and scratching assay were measured during 24 hours. The migration assay was also performed after overnight incubation with healthy control plasma and active GPA patient plasma. Three patients with active disease where submitted to recollection of ECFC after treatment for longitudinal evaluation. RESULTS The culture was successful in 62% of GPA patients and 57% of controls. In the matrigel assay the ECFC from patients and controls showed similar capillary structures formation, however ECFC from inactive GPA alone showed early loss of angiogenic capacity between 15 and 24 hours. In scratching assay, there was an impairment in the proliferative capacity of the ECFC between GPA patients and controls without significant difference (12th hour, p = 0.05). When incubated with control plasma, ECFC of remission GPA patients showed a significant lower migration capacity after the 4th hour (p = 0.0001). In longitudinal analysis, ECFC isolated after treatment showed significantly lower migration rates. CONCLUSIONS PR3-positive remission GPA ECFC demonstrated early loss of tube formation and less proliferative capacity compared to those of healthy controls, suggesting impairment of endothelial function.

Cecília de Morais Barbosa,1 Manoel Barros Bértolo,2 Juliana Zonzini Gaino,2 Michael Davitt,3 Zoraida Sachetto,2 Eduardo de Paiva Magalhães3 1Department of Internal Medicine, Gerontology, Faculty of Medical Sciences, State University of Campinas – Unicamp, Campinas, SP, Brazil; 2Department of Internal Medicine, Rheumatology, Faculty of Medical Sciences, State University of Campinas – Unicamp, Campinas, SP, Brazil; 3Orthoses and Prostheses Unit, Clinical Hospital, State University of Campinas – Unicamp, Campinas, SP, Brazil Background: Aging is associated with reduced postural stability and increased fall risk. Foot orthoses have been reported as an adjuvant intervention to improve balance by stimulating foot plantar mechanical receptors and thus increasing somatosensory input. Purpose: The aim of this study is to evaluate the effect of flat and textured insoles on the balance of primary care elderly people. Design: Prospective, parallel, randomized, and single-blind trial. Methods: A total of 100 subjects from a primary care unit, aged ≥65 years, were randomly assigned to intervention groups with flat insoles (n=33), textured insoles (n=33), or control group (n=34) without insoles. The Berg Balance Scale and the Timed Up and Go test were assessed at baseline and after 4 weeks. Results: Improvements in the Berg Balance Scale and the Timed Up and Go test were noted only in intervention groups with insoles but not in control group. No significant difference was found between flat and textured insoles. Minor adverse effects were noted only in the group with textured insoles. Conclusion: The results suggest that foot orthoses (both flat and textured insoles) are effective in improving balance in primary care elderly people. They may represent a low-cost and high-availability adjuvant strategy to improve balance and prevent falls in this population. Keywords: balance, elderly, orthoses, insole

The rheumatic diseases, which include systemic lupus erythematosus, rheumatoid arthritis, Behçet's disease, scleroderma, and ankylosing spondylitis, are characterized by involvement of connective tissue, with multiple manifestations. In those diseases, there can be involvement of the peripheral or central nervous system, and that involvement can be primary, presenting as a major feature of the clinical presentation, or secondary, as an effect of the drugs used in order to control a given disease or its complications. Knowledge of the wide variety of imaging findings is crucial to the diagnosis of a rheumatic disease, especially in the early stages, enabling effective treatment and minimizing disability. This pictorial essay, presenting cases from the records of two tertiary teaching hospitals, encompasses cases of patients diagnosed with rheumatic disease and illustrates the neuroradiological findings on magnetic resonance imaging and computed tomography, in order to emphasize the importance of these methods for properly diagnosing rheumatic diseases. Resumo As doenças reumatológicas, que incluem lúpus eritematoso sistêmico, artrite reumatoide, doença de Behçet, esclerodermia e espondilite anquilosante, são caracterizadas por envolvimento do tecido conjuntivo, com múltiplas manifestações. Nessas doenças, o envolvimento do sistema nervoso central ou periférico pode ser primário, apresentando-se como uma das principais características clínicas, ou secundárias, como efeito das drogas usadas para seu controle. O diagnóstico, especialmente nas fases iniciais, depende do conhecimento de grande variedade de achados em métodos de imagem, permitindo um tratamento eficaz, causando menores deficiências. Este ensaio, com casos de um arquivo didático de dois hospitais terciários, engloba pacientes com diagnóstico de doenças reumatológicas e ilustra os achados neurorradiológicos de ressonância magnética e tomografia computadorizada, a fim de enfatizar a importância desses métodos para o diagnóstico adequado.

Granulomatosis with polyangiitis (GPA) is a potentially lethal disease characterized by systemic necrotizing vasculitis, which affects small- and medium-sized blood vessels and is often associated with serum cytoplasmic antineutrophil cytoplasmic antibody. The upper and lower respiratory tract and kidney are the most involved sites, but oral lesions can be identified in 6-13% of the cases, whereas in only 2% of the cases, oral manifestations represent the first signal of the disease usually as gingival swellings or unspecific ulcerations. Without treatment, the mainstay of which is the combination of immunosuppressants and systemic corticosteroids, GPA may run a fatal course. In this report we describe an original case of GPA affecting a 75-year-old female patient referred to our service due to a gingival swelling with 3-month duration. Although the patient was correctly diagnosed and promptly treated, she died 3 months after the initial diagnosis.

Background: Rheumatoid patients(RA)have increased rate of falls and an impaired balance. Foot orthoses are commonly used in RA. Despite the evidence of pain relief with foot orthoses, it is not clear if their use can improve or even impair balance in RA. Objectives: The aim of this study was to evaluate the effect of foot orthoses on balance of RA patients. Methods: 94 RA patients in the outpatient clinic of the Rheumatology Division of Unicamp were randomly assigned to intervention group/IG(n=48)with foot orthoses or control group/CG(n=46)without orthoses. At initial visit, subjects were assessed regarding:sociodemographic and clinical data(number of falls in last year, fear of falling, disease duration, rheumatoid factor, lmedication, visual impairment, vertigo, physical activity, body mass index, comorbidity index, foot tactile sensitivity, number of lower limbs swollen and tender joints count, disease activity-CDAI and disability-HAQ). Subjects answered The Foot Function Index-FFI and were submitted to Berg Balance Scale-BBS, the Timed Up and Go-TUG and the 5-Time Sit Down-to-Stand up-SST5 tests.IG subjects received custom made insoles according to each foot needs. After four weeks, subjects were reassessed for FFI, BBS and TUG. To compare baseline values of groups, the chi-squared test, Fisher’s exact test and Mann-Whitney test were applied.ANOVA for repeated measures was used to compare differences between groups and times for BBSTUG and FFI. Effect size was analyzed using the Cohen9s d test. All data were analyzed with a 5%level of significance. Results: 81 subjects completed the research protocol,40 in the IG and 41 in the CG. Groups were similar at baseline for most variables with exception of comorbidity index(worst index in IG) and race(p Conclusions: Foot orthoses were well accepted and worn during long periods with FFI and balance tests (BBS, TUG)improvement. Prospective placebo controlled studies are recommended to assure the possibility to use insoles as adjuvant interventions to improve balance in RA. References 1. Hennessy K, Woodburn J, et al. Custom foot orthoses for rheumatoid arthritis: A systematic review2012Mar;64(3):311–20. 2. de P Magalhaes E, Davitt M, et al. The effect of foot orthoses in rheumatoid arthritis.Rheumatology2006;45(4):449–53. 3. Clark H, Rome K, et al. A critical review of foot orthoses in the rheumatoid arthritic foot. Rheumatology2006;45(2):139–45. 4. Metli N, Kurtaran A, et al. Impaired Balance and Fall Risk in Rheumatoid Arthritis Patients. Annals of the Rheumatic Diseases2014;73:906. Disclosure of Interest: None declared

Background Feet are involved in 90%of Rheumatoid arthritis (RA) patients. The Structural Index Score(SIS) is a score that evaluates forefoot and rearfoot aspects. Although it has been used as a clinical tool to quantify foot deformities in RA, its relevance in clinical practice is uncertain. Objectives The aim of this study was to evaluate the relation of SIS with foot function, disability and physical performance tests in RA. Methods 104 RA patients of the outpatient clinic of Rheumatology/Unicamp were evaluated for SIS total, forefoot, rearfoot and its items (hallux valgus, metatarsalphalangeal (MTP) subluxation, 5th MTP exostosis, claw/hammer toe deformities, calcaneus varus/valgus angle, ankle range of motion (ARM) and planus/cavus foot deformity). Subjects also performed Foot Function Index-FFI, Health Assessment Questionnaire Disability Index-HAQ-DI, lower limb HAQ-LL-HAQ and physical tests: Berg Balance Scale-BBS, the Timed Up and Go-TUG and the 5-time sit down-to-stand up-SST5 tests.SIS items were compared with HAQ, LL-HAQ, FFI and physical tests through Kruskal- Wallis test and Spearman correlation coefficient with a 5% level of significance. Results SIS-Forefoot score did not correlate with any variables. Among the SIS-forefoot items, hallux valgus was associated with FFI-pain (p=0.007), FFI-disability(p=0.005)and FFI-total (p=0.016); MTP subluxation was weakly correlated with FFI-disability (rs=0.196) and 5th MTP exostosis was associated with FFI-pain(p=0.018). SIS-Total, SIS-Rearfoot and its associated and correlated items are shown in table 1. Conclusions It is not clear if the use of SIS may be related to function and disability in RA. Forefoot SIS did not show correlation although hallux valgus, MTP subluxation and 5th MTP exostosis may be related to foot function. Rearfoot SIS and its items seem to be most correlated with function and disability in RA. References [1] Kerry RH, et al. The foot in chronic rheumatoid arthritis:a continuing problem. The Foot1994;4:201–3. [2] Turner DE, et al. Biomechanics of the foot in rheumatoid arthritis:identifying abnormal function and the factors associated with localised disease’impact’.Clin Biomech2008;23(1):93–1003. [3] Platto MJ, et al. The relationship of pain and deformity of the rheumatoid foot to gait and an index of functional limitation. J Rheumatol1991;18:38–43. [4] Goksel Karatepe A, et al. Foot deformities in patients with rheumatoid arthritis: the relationship with foot functions. Int J Rheum Dis. 2010;13(2):158–63. Disclosure of Interest None declared

Background Rheumatoid patients(RA)are known to have an increased falls incidence with a threefold increased risk of hip fracture. Few studies have been conducted to evaluate the relation between falls, disease activity, disability and physical functioning. Objectives To evaluate the prevalence of falls in RA and its relation with disease activity, disability and physical performance tests. Methods 113 RA patients were evaluated from the outpatient clinic of the Rheumatology Division of the State University of Campinas/Unicamp. Patients were assessed for occurrence of falls in last year, fear of falling, sociodemographic and clinical data (medication, visual impairment, vertigo, physical activity, body mass index, disease duration, rheumatoid factor, lower limb swollen and tender joints, foot tactile sensitivity, disease activity-CDAI and disability-HAQ). Subjects were submitted to Berg Balance Scale-BBS, the Timed Up and Go Test-TUG and 5-Time Sit Down-to-Stand Up Test-SST5 and were divided in “Fallers” and “Non-Fallers” groups. For comparison of groups the chi-squared test, Fisher’s exact test and Mann-Whitney were used. Univariate linear regression and multivariate analysis were used to analyse the relation between sociodemographic, clinical data and physical tests with the occurrence of falls. Kruskal- Wallis test was used for analysis of the association of BBS, TUG and SST5 with CDAI and HAQ. The data were analysed with a 5% level of significance. Results 52.21% reported the occurrence of falls in the past 12 months and 62.8%were fearful of falling. Comparing “Fallers” and “Non-Fallers”, significant differences were noted for HAQ(p=0.0242), fear of falling(p=0.0196) and BBS(p=0.0120). After univariate logistic regression there was association of falls with income(OR 1.05), HAQ(OR 1.945), fear of falling(OR 2.586) and TUG (OR 1.09). In multivariate model, income was independently linked to falls(OR 1.07). BBS, TUG, SST5 were correlated with CDAI and HAQ(p Conclusions RA patients have high prevalence of falls and fear of falling. Income was an independent fall risk factor. BBS seems to be higher among fallers and TUG can be considered a fall risk predictor. BBS, TUG and SST5 are related to CDAI and HAQ. CDAI does not seems to be a good instrument to predict falls due to its variability over time. In clinical practice, HAQ can be a valuable tool to recognise patients with an increased risk of falls. References [1] Stanmore EK, Oldham J, Skelton DA, et al. Risk factors for falls in adults with rheumatoid arthritis: a prospective study. Arthritis Care Res2013Aug;65(8):1251–8. [2] Brenton-Rule A, Dalbeth N, Menz HB, et al. The incidence and risk factors for falls in adults with rheumatoid arthritis: a systematic review. Semin Arthritis Rheum2014;44:389–98. [3] Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J AmGeriatr Soc1991; 39:142–8.16. [4] Berg KO, Maki BE, Williams JI, et al. Clinical and laboratory measures of postural balance in an elderly population. Arch Phys Med Rehabil1992;73:1073–1080. [5] Bohannon RW. Test-retest reliability of the five-repetition sit-to-stand test: a systematic review of the literature involving adults. J Strength Cond Res2011; 25:3205–7. Disclosure of Interest None declared

Patients with rheumatoid arthritis (RA) are at increased risk of falls, with potential adverse outcomes. There is a considerable variation across studies regarding the prevalence of falls and its correlation with clinical data, disease-related outcomes and physical performance tests.The aim of this study was to evaluate the prevalence of falls and its association with clinical data, disease-related outcomes and physical performance tests.In this cross-sectional study, 113 RA patients were divided into 3 groups - "non-fallers", "sporadic fallers" and "recurrent fallers" - and compared in terms of clinical data, Clinical Disease Activity Index (CDAI), lower-limb tender and swollen joint count, disability (Health Assessment Questionnaire-Disability Index [HAQ-DI]), Foot Function Index (FFI), Berg Balance Scale (BBS), Timed-up-and-go Test (TUG) and 5-Time Sit Down-To-Stand Up Test (SST5). Logistic regression analysis was performed to analyze the associations between the studied variables and the occurrence of falls, estimating odds ratios (ORs). We also analyzed the correlation between disease outcome measures (HAQ-DI and CDAI) and physical tests (BBS, TUG, SST5).Falls and fear of falling were reported by 59 (52.21%) and 71 (64.5%) patients, respectively. Significant associations were found between "recurrent fallers" and vertigo (OR=3.42; P=0.03), fear of falling (OR=3.44; P=0.01), low income (OR=2.02; P=0.04), CDAI (OR=1.08; P0.01), HAQ-DI (OR=3.66; P0.01), Lower-limb HAQ (OR=3.48; P0.01), FFI-pain (OR=1.24; P=0.03), FFI-total (OR=1.23; P=0.04), lower-limb tender joint count (OR=1.22; P0.01), BBS score (OR=1.14; P0.01), TUG score (OR=1.13; P=0.03) and SST5 score (OR=1.06; P=0.02). On multivariate analysis, CDAI was the only significant predictor of recurrent falls (OR=1.08; P0.01). Physical performance test scores (BBS, TUG, SST5) were correlated with the CDAI and HAQ-DI.The prevalence of falls in RA is high, most influenced by disease-related outcomes and linked to worse performance on physical tests (BBS, TUG and SST5).

IntroductionOtorhinolaryngological manifestations of rheumatologic diseases represent a great challenge not only to the generalistphysician but also to the ENT doctor andrheu- matologist. They often represent early manifestations of an autoimmune disorder which requires prompt and aggressive immunosuppressive treatment. Auditory, nasal, laryngeal and eye symptoms can be the first manifestation of rheumatic diseases and their proper assessment helps the doctor to identify signs of disease activity. The objective of this study is to identify the ENT manifestations in patients with rheumatic diseases in a high comple- xity hospital, regarding facilitating an early diagnosis and treatment.MethodsWe performed clinical and complete otorhinolaryngological evaluations in pa- tients selected from the outpatient rheumatology in a standardized manner by the use of a standardized form filling during the secondhalf of 2010.ResultsIn the study group, systemic lupus erythematosus (SLE) patients had predomi- nantly laryngeal manifestations, while patients with Sjögren's syndrome showed a higher prevalence of otologic manifestations. Changes in audiometric tests were found in 53% of Wegener's granulomatosis (WG) patients, 80% of relapsing polychondritis (RP), 33% of systemic lupus erythematosus (SLE) and 50% of Churg-Strauss syndrome (SCS). Regarding nasal alterations, these were found so prevalent in all conditions, especially Churg-Strauss syndrome.Discussion and conclusionThis study demonstrated that most patients treated in our hospi- tal has the ENT signs and symptoms commonly associated in previous studies on rheuma- tic diseases, but further studies with a larger number of patients must be made to establish such relations.

Objectives. The aim of this study was to evaluate human leukocyte antigen (HLA) involvement in the disease expression and poor prognostic clinical features (pulmonary fibrosis and pulmonary arterial hypertension) in patients diagnosed with systemic sclerosis (SSc) in a multiethnic population.Methods. SSc patients followed up between 2008 and 2011 were included, and clinical data were obtained through records review. Molecular HLA typing was performed (polymerase chain reaction amplification technique using specific primer sequences). The statistical analysis involved Fisher’s exact test and Pearson's corrected chi-square test.P values≤0.05were considered significant. The delta method was used to estimate the variance of the prevalence ratio (PR).Results. A total of 141 patients (120 women and 21 men) with SSc were studied, including 33.3% with diffuse cutaneous SSc (dcSSc), 62.4% with limited cutaneous SSc (lcSSc), and 4.3% with sine scleroderma. Pulmonary fibrosis was present in 61 patients (43.3%), and the HLA-A*30 and DQB1*04 alleles were related to susceptibility. In contrast, the HLA-DRB1*01 and DQB1*05 alleles were protective. Pulmonary arterial hypertension was diagnosed in 19 patients (13.5%) and was associated with HLA-B*35 and C*04; in contrast, C*03 seemed to be protective.Conclusions. Our current study documents the association of some classes I and II HLA alleles with the most severe clinical manifestations in a multiethnic case series. Our findings differed slightly from the previous data in other populations.

OBJECTIVES: Rheumatoid arthritis is a polygenically controlled systemic autoimmune disease. Rheumatoid vasculitis is an important extra-articular phenotype of rheumatoid arthritis that can result in deep cutaneous ulcers. The objective of this study was to establish a correlation between the frequency of major histocompatibility complex class I/II alleles and killer immunoglobulin-like receptor genotypes in patients with cutaneous rheumatoid vasculitis. METHODS: Using the Scott & Bacon 1984 criteria to diagnose rheumatoid vasculitis and after excluding any other causes such as diabetes, atherosclerosis, adverse drug reactions, infection, and smoking, patients who met the criteria were selected. All of the selected rheumatoid vasculitis patients presented deep cutaneous ulcers. Identification of the major histocompatibility complex class I/II and killer immunoglobulin-like receptor genotypes was performed by polymerase chain reaction assays of samples collected from the 23 rheumatoid vasculitis patients as well as from 80 controls (40 non-rheumatoid vasculitis RA control patients and 40 healthy volunteers). RESULTS: An association between the presence of the HLA-DRB1*1402 and HLA-DRB1*0101 alleles and cutaneous lesions in rheumatoid vasculitis patients and a correlation between the inhibitor KIR2DL3 and the HLA-C*0802 ligand in rheumatoid vasculitis patients were found. CONCLUSION: An association was found between the presence of the HLA-DRB1*1402 and HLA-DRB1*0101 alleles and the development of cutaneous lesions in rheumatoid vasculitis patients. Additionally, the HLA-C*0802 ligand protects these individuals from developing cutaneous lesions.

Parvovirus B19 (B19) has been implicated in the aetiopathogenesis of some cases of systemic vasculitis, mainly giant cell arteritis.1 A positive serological test for B19 has been reported in a few patients with polyarteritis nodosa (PAN).2–4 As far as we know no studies of B19 DNA in tissue samples of patients with PAN have been published, so we used a nested polymerase chain reaction (PCR) approach to screen for B19 DNA in fixed paraffin embedded tissue samples from patients with PAN and microscopic polyangiitis (MPA). The diagnosis was based on the Chapell-Hill Consensus Conference guidelines.5 Only tissue samples from patients with vasculitis were used for DNA preparations. DNA was extracted using a commercial kit (DNeasy tissue kit, Quiagen). A nested PCR for B19 was carried out using a previously published set …

Background: Behçet disease (BD) is a systemic chronic vasculitis, in which Th 1 polarized immune response and plays a major role in the pathogenic process. The anti-TNFα, is the highest effectiveness treatment, but presents some limitations such as high costs and side effects. Recently, platelets have shown emerging role as immune cells with multiple inflammatory and immune regulators proteins. The aim of this study was to characterize autologous PRP of patients with BD, and evaluate its effects as immunomodulator through its subcutaneous application. Methods: Eight patients with BD were evaluated in over a year. PRP therapy was applied during six months with a total of 9 PRP injections (first 6 every two weeks, last 3 monthly). Immunomodulation provide by platelets was assessed in five time points: basal, 3 (3M), 6 (6M), 9 (9M) and 12 (12M) months after the first PRP injection. Patients samples were evaluated to: frequency of effectors T cells (CD4+; CD8+), regulatory T cells (CD4+, CD25+,FOXP3+), activated/no activated NK cells (CD 69+CD56+), (CD16+CD56+), cytokines profile such as TNF-α, IFN-γ IL-1β, IL-2, IL-6, IL-8, IL-10, IL-12, IL-13, IL-17, IL-21, PF4, CD40L by CBA, and growth factors (GF) TGF-β, PDGF, EGF, and VEGF through Luminex. PRP was characterized regarding number of leukocytes, platelets and the same cytokines and growth factors analyzed in plasma samples. Results: PRP were concentrated in a median of 5 folds related to the basal of platelet numbers, demonstrating a high recovery of platelets. The median of leukocytes cells were 0.5 folds related to their basal number that evidenced a poor concentration of leukocytes in the PRP. PRP GF maintained similar levels during the treatment, except for a significantly increase of TGF-β1 (p Conclusion: As a very interesting and novel finding we evidenced that autologous subcutaneous injections of PRP showed an immunomodulation in BD patients. The inflammatory profile decreases, whereas the regulatory profile increased during PRP injections. The autologous PRPs were extensively characterized, especially for GF and PF4. The first one presents a role in angiogenesis, adhesion molecule expression and PF4 is a chemokine that in turn interacted with monocytes, neutrophils, T-cell recruitment and Th differentiation. We could observe that the frequency of PRP injections and period of action is determinant for biologic effect. The best results were obtained along 3 months of treatment with an interval of 15 days between PRP injections. The advantage of PRP when compared to biological therapy available, such as anti-TNF-α, is the low cost, no immunogenicity and minor side effects. This study suggested a beneficial effect of autologous PRP therapy on biologic profile of BD patients and encourages the development of trials with higher number of patients in randomized studies to analyze clinical efficacy and safety. Figure 1 The frequency of activated NK cells (a) and regulatory T cells (b) in plasma samples of patients. * Patients were in use of higher doses of corticoids. Figure 1. The frequency of activated NK cells (a) and regulatory T cells (b) in plasma samples of patients. * Patients were in use of higher doses of corticoids. Disclosures No relevant conflicts of interest to declare.

The aim of this report is to verify the demographic, clinical, laboratorial and histopathological findings of patients with CSS followed in a University Clinical Hospital. We reviewed the medical records of all patients with the diagnosis of CSS. Only patients who fulfilled ACR criteria were included. Five Caucasian patients were found, with a sex ratio M/F: 3/2. The mean age at disease onset was 46 years old (40 to 55) and the mean time of follow-up was 2.37 years (0.25 to 6). General symptoms, asthma, peripheral neuropathy and skin lesions were the most common clinical findings in all patients. Cardiovascular, gastrointestinal and renal involvement was found in one patient each. All patients presented hypereosinophilia (10%) and p-ANCA was present in 3 patients. The chest x-ray showed pulmonary parenchymal infiltrate in 2 cases and in 1 of them an unilateral pleural effusion. Skin biopsies showed extravascular eosinophylia in 3 out of 4. All patients were treated with prednisone and in 3 it was added immunosuppressive drug. No patient died during the follow-up. CSS is a rare disease with a multivisceral involvement and asthma is the main and the earliest symptom. General symptoms and involvement of skin and peripheral nerves were found in all patients. Renal, cardiovascular and gastrointestinal involvement was rare, differently from the literature series where these findings are more frequent. In spite of the CSS being a serious and life-threatening disease, these patients presented adequate response to the treatment and a favorable outcome.

Orientadores: Manoel Barros Bértolo, Lilian Tereza Lavras Costallat Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas Resumo: Objetivo: Descrever os dados demográficos e as manifestações clinicas de pacientes com diagnostico de Doença de Behcet acompanhados no ambulatório de vasculites do Hospital das Clinicas da cidade de Campinas, São Paulo, Brasil. Métodos: O estudo foi realizado através da revisão dos prontuários de todos os pacientes com diagnostico de Doença de Behcet atendidos e/ou acompanhados no ambulatório de vasculites da Disciplina de Reumatologia do Hospital das Clinicas da Universidade Estadual de Campinas, São Paulo, Brasil, no período de 1988 a 2010. Resultados: Foram incluídos no estudo oitenta e sete pacientes. A proporção entre os sexos foi de M/F = 0,84 e a media de idade do inicio da doença foi de 28,03 + ou - 7,57 anos. Lesão aftosa oral foi a manifestação clinica mais comum (100%). Ulceras genitais também foram comuns (77%), seguidas pela pseudofoliculite (47,67%). Envolvimento ocular esteve presente em 80% e envolvimento neurológico em 31,03% dos pacientes. Artralgia foi relatada em 31,03% e artrite em 13,79% dos casos. O envolvimento vascular foi encontrado em 13,95% dos pacientes. Somente 1,14% apresentaram envolvimento gastrointestinal. Conclusão: Nesta serie de casos, realizada em um pais da America do Sul, foram encontrados resultados semelhantes aos previamente descritos em diferentes áreas endêmicas da doença, com uma maior frequência das manifestações oculares e neurológicas Abstract: Objective: To analyze demographic and clinical features in patients diagnosed with Behcet's disease (BD) in Brazil. Methods: We performed a retrospective review of all the patients' records with BD diagnosed from 1988 to 2010 in the Rheumatology Department at the State University of Campinas (UNICAMP). All patients had to fulfill the International Study Group for Behcet's disease diagnostic criteria. Results: Eighty-seven patients were included in the study. The male/female rate was 0,84 and the mean age at the onset of the disease was 28.03 + or - 7.57 years. Oral aphtosis was the most frequent manifestation (100%). Genital aphtosis was also frequent (77%), followed by pseudofolliculitis (47.67%). Ocular symptoms were present in 80% and neurologic manifestations in 31.03% of the patients. Arthralgia was reported in 31.03% and arthritis in 13.79% of the cases. Vascular involvement was seen in 13.95% of the patients. Only 1.14% had gastrointestinal involvement. Conclusion: This series, from a South American country, showed a similar general pattern of the BD to those found in different endemic areas in the world, with a high frequency of ocular and neurological manifestations Doutorado Clínica Médica Doutor em Clínica Médica