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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.

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.

INTRODUCTION: Numerous experimental efforts have been undertaken to induce the healing of lesions within articular cartilage by re-establishing competent repair tissue. Adult mesenchymal stem cells have attracted attention as a source of cells for cartilage tissue engineering. The purpose of this study was to investigate chondrogenesis employing periosteal mesenchymal cells. METHODS: Periosteum was harvested from patients who underwent orthopedic surgeries. Mesenchymal stem cells were characterized through flow cytometry using specific antibodies. The stem cells were divided into four groups. Two groups were stimulated with transforming growth factor β3 (TGF-β3), of which one group was cultivated in a monolayer culture and the other was cultured in a micromass culture. The remaining two groups were cultivated in monolayer or micromass cultures in the absence of TGF-β3. Cell differentiation was verified through quantitative reverse transcription-polymerase chain reaction (RT-PCR) and using western blot analysis. RESULT: In the groups cultured without TGF-β3, only the cells maintained in the micromass culture expressed type II collagen. Both the monolayer and the micromass groups that were stimulated with TGF-β3 expressed type II collagen, which was observed in both quantitative RT-PCR and western blot analysis. The expression of type II collagen was significantly greater in the micromass system than in the monolayer system. CONCLUSION: The results of this study demonstrate that the interactions between the cells in the micromass culture system can regulate the proliferation and differentiation of periosteal mesenchymal cells during chondrogenesis and that this effect is enhanced by TGF-β3.

Este estudo tem como objetivo identificar os fatores sociodemográficos, clínico-funcionais e psicocognitivos associados ao histórico de quedas de idosos saudáveis. A amostra foi constituída por 96 idosos divididos igualmente em três grupos de acordo com o histórico de quedas ocorrido no último ano (sem queda, uma queda e quedas recorrentes). Não houve diferença entre os grupos quanto aos dados sociodemográficos. Os idosos do grupo sem quedas apresentaram menor queixa de dor (p = 0,012) e de tontura (p = 0,003), melhor mobilidade (p < 0,001), capacidade funcional (p < 0,001) e menor relato de quase quedas (p = 0,003) quando comparados aos idosos dos grupos com histórico de quedas. Na avaliação psicocognitiva os idosos com quedas recorrentes revelaram maior escore para humor deprimido (p = 0,009) e maior déficit cognitivo (p = 0,040) do que os sem quedas. As quedas interferem de forma negativa na vida do idoso, motivo da importância de identificação dos fatores protetores e potencializadores deste evento. Com o reconhecimento desses fatores é possível que os profissionais possam prevenir as quedas ou as consequências debilitantes causadas por sua ocorrência. This study aims at identifying the sociodemographic, clinical-functional and psycho-cognitive factors associated with the history of falls of community-dwelling elderly individuals assisted by Programa Saúde da Família (PSF - Family Health Program). The sample comprised 96 elderly subjects equally divided into three groups according to the report of falls that occurred during the past year, as follows: without falls, one fall or recurrent falls. There were no significant differences between groups in relation to sociodemographic data. The non-faller group presented less complaints about pain (p=0.012) and dizziness (p=0.003), and less near-falls reports (p=0.003) when compared to the faller groups. Besides, it presented better mobility (p

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

Orientador : Lilian T. Lavras Costallat Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas Resumo: Tendo em vista os poucos dados referentes às taxas de fertilidade, frequência de abortamentos e sua recorrência entre as mulheres lúpicas em nosso meio, o autor se propõs a estudar a fertilidade numa população de pacientes lúpicas da região de Campinas, comparando-as com uma população de mulheres normais, analisando aocorrência ou recorrência de abortos nestas populações, a frequência dos anticorpos anticardiolipina entre as lúpicas e a importância dos fatores clinicos, laboratoriais e terapêuticos na história gestacional destas pacientes. Foram estudados retrospectivamente 186 pacientes do sexo feminino com Lupus Eritematoso Sistêmico ( LES ) diagnosticados e acompanhados no ambulatório da Disciplina de Reumatologia da Faculdade de Ciências Médicas da UNICAMP. O grupo controle foi constituido por 131 mulheres higidas que compareceram ao pronto socorro do Hospital das Clinicas. A taxa de fertilidade das lúpicas estudadas foi semelhante às da literatura, bem como também à das mulheres normais no Estado de São Paulo. Houve um menor número de gestações entre as pacientes, bem como um maior número de mulheres que nunca engravidaram, quando comparados com as do grupo de mulheres higidas. Houve um número significativamente maior de abortos entre as pacientes, não tendo sido verificada associação com o anticorpo anticardiolipina. Não houve diferenças significativas em relação às manifestações clinicas, laboratoriais e esquemas terapêuticos empregados quando comparadas as lúpicas que engravidaram das que nunca tiveram gestação Abstract: Although a large proportion of patients with systemic lupus erythemathosus (SLE) are women of reproductive age, aclear picture of the effects of the disease on pregnancy and vice versa was slow to emerge. The initial small retrospective studies of this interaction yielded conflicting results. Confounding factors were the lack of agreed criteria for the diagnosis of exacerbation and the potential confusion among certain features of normal pregnancy and lupus fIare. Besides the lupus effect on fertility rate wasn't ex~lored enough. There are few studies and alI of the~out of our country. In order to study the fertility among SLE patients followed at the State University of Campinas between 1973 to 1992, and to analyse the abortions, anticardiolipin antibody (aCL) freguency and the clinical, laboratorial and therapeutic aspects importa~ce on the reproductive history of those patients,186 lupic patient,s, compared to 131 normal women, were studied retrospectively. The mean age among lupic patients was 32,77 years-old, a~d 33,98 among the controls. The number of pregnancies was lower in patients than in controls, as well as agreater number of patients that never had pregnancy than those ones controlled. Abortions were present in a higher number among the lupic patients and the difference between the groups was Statisticly significant. However, this feature was not related to the aCL positivity. There clinical management had noto were not significant differences and laboratorial features, as well as in the relation to therapeutic among the patients who had pregnancies and those who had not Mestrado Mestre em Medicina

Background : Articular cartilage is a unique tissue in that it is avascular with its nutrition and oxygen supply being dependent on the diffusion of solutes through the synovial fluid and to and from the subchondral bone. The oxygen levels in articular cartilage, therefore, are assumed to be low. Oxygen is an important modulator of gene expression and this regulation occurs largely through the activation of the transcriptional complex hypoxia-inducible factor-1 (HIF-1). However, little is known about how articular cartilage regulates genes in response to O 2 tension and whether this regulation occurs through HIF-1. Aim : The aim of this study was to investigate the expression profile of HIF-1α in normal and osteoarthritic (OA) chondrocytes under normoxic and hypoxic conditions, and in response to treatment with tumor necrosis factor alpha (TNFα). Methods : Articular chondrocytes from human normal and OA knee cartilage were isolated and cultured in suspension under normoxic (21% O 2 ) or hypoxic conditions (1% O 2 ). Chondrocytes were also treated with TNF-α under normoxic conditions. Nuclear extracts and total RNA were prepared and HIF-1α protein and mRNA levels were assayed by immunoblotting and Northern hybridization. Localization of HIF-1α by immunofluorescence was performed on frozen sections of cartilage tissue by confocal microscopy. Results : HIF-1α expression was detectable in human normal and OA chondrocytes and cartilage by Northern analysis, immunoblotting and immunofluorescence under normoxic conditions. Culture of OA or normal chondrocytes under hypoxic conditions for up to 16h resulted in a modest stabilization and/or increase of HIF-1α expression. Treatment of articular chondrocytes with TNFα resulted in an increase in HIF-1α protein steady state levels under normoxic conditions. The increase in HIF-1α expression induced by TNFα was partially blocked by pretreatment of the chondrocytes with inhibitors of NFκB or p38 MAP kinase. We also observed the expression of HIF-2α mRNA in human chondrocytes. Conclusion : HIF-1α is expressed in human normal and OA articular chondrocytes cultured under normoxic conditions. HIF-1α can be further induced or stabilized in articular chondrocytes by hypoxia or by treatment with TNFα. The relatively high constitutive expression of HIF-1α by chondrocytes may be an important adaptation to survival in the avascular-hypoxic environment of cartilage. Modulation of HIF-1α levels by TNF-α may have important implications for chondrocyte metabolism during degenerative joint disease. In addition, we detected for the first time the expression of HIF-2α mRNA in chondrocytes.

Background The purpose of this study was to investigate the influence of muscle mass and bone mineral density on markers of mobility in dwelling elderly women. Methods This cross-sectional study included 99 elderly women, who were 65 years old or above, in Campinas-SP, Brazil. To collect data, we used sociodemographic data, the body mass index (BMI), health status, comorbidities, use of medications, mobility tests (TUG and gait speed) and examinations of the body composition (densitometry with dual-emission X-ray absorptiometry “DXA”). In order to examine the relationship between muscle and bone mass with mobility (gait speed and TUG), we applied the Spearman correlation coefficient. Also was applied the analysis of covariance (ANCOVA) adjusted for age and comorbidities. To identify the factors associated with mobility, we used the univariate and multivariate logistic regression analysis. The level of significance for statistical tests was P

INTRODUÇÃO: A osteoartrite (OA) de joelhos apresenta alta prevalência, com grande impacto social e econômico. Porém, seu tratamento ainda é relativamente limitado porque as terapias existentes até o momento apresentam duração curta e tamanho de efeito apenas pequeno a moderado. Na busca por novas opções, o Plasma Rico em Plaquetas (PRP) tem mostrado eficácia em alguns ensaios. No entanto, esses estudos apresentam falhas metodológicas importantes, não existe padronização no preparo do PRP e apenas 3 deles usaram placebo como comparador. Já o plasma (sem as plaquetas) não foi testado como tratamento até o momento. O objetivo deste estudo foi avaliar se a infiltração intra-articular de plasma rico em plaquetas (PRP) ou plasma é superior ao placebo para melhorar a dor ou a função em participantes com OA de joelhos em 24 semanas. MÉTODO: ensaio clínico randomizado, duplo-cego, placebo-controlado com 3 grupos: PRP (n = 20), plasma (n = 21) e soro fisiológico (n = 21). Foram realizadas 2 infiltrações guiadas por ultrassom com intervalo de 2 semanas. O desfecho primário foi a dor geral no joelho estudado pela escala visual analógica 0-10 cm (EVA) avaliada na semana 24, com avaliações intermediárias nas semanas 6 e 12. Os desfechos secundários foram: EVA de dor em repouso e em movimento, avaliação global do paciente e do médico, escala likert de melhora, WOMAC (Western Ontario McMaster Universities Osteoarthritis Index), KOOS (Knee Injury and Osteoarthritis Outcome Score), critério OMERAC-OARSI e o TUGT (Timed Up and Go Test). RESULTADOS: Os grupos eram semelhantes na inclusão: 57 (92%) participantes eram do sexo feminino, com média de idade de 65 anos, média de índice de massa corporal de 28,0 kg/m2 e média da EVA para dor geral de 6,2 cm. Os deltas de melhora da dor geral na semana 24 foram -2,9 (DP 2,5), -2,4 (DP 2,5) e -3,5 (DP 3,3) cm para o PRP, o plasma e o soro fisiológico, respectivamente (p intergrupo = 0,499). Nas semanas 6 e 12 também não houve diferença entre os grupos. Da mesma forma, não houve diferença entre os grupos quanto aos desfechos secundários, exceto na escala likert para melhora, em que houve uma diferença significativa no grupo PRP entre as semanas 6 e 12, sugerindo melhores respostas na semana 12 (p = 0,003). Eventos adversos ocorreram em 13 (65%) participantes do grupo PRP, 5 (24%) do grupo plasma e 7 (33%) do grupo soro fisiológico (p = 0,02), sendo o mais comum a dor leve a moderada, com duração média de 2 dias, porém não houve diferença entre os grupos quanto ao tipo, intensidade e duração dos sintomas. CONCLUSÕES: o PRP e o plasma não foram superiores ao placebo para melhora da dor e função em participantes com OA de joelhos no período de 24 semanas. O grupo PRP apresentou maior frequência de eventos adversos, mas o tipo, a intensidade e a duração não foram diferentes entre os grupos INTRODUCTION: Knee osteoarthritis (OA) has a high prevalence, with great social and economic impact. Nevertheless, its treatment is still relatively limited because existing therapies are of short duration and have small to moderate effect sizes at best. In the search for new options, Platelet Rich Plasma (PRP) has shown efficacy in some trials. However, these studies have major methodological flaws, there is no standardization in PRP preparation and only 3 of them used placebo as comparator. On the other hand, the plasma (without platelets) has not been tested as a treatment so far. The aim of this study was to evaluate whether intra-articular platelet-rich plasma (PRP) or plasma are superior to placebo to improve pain or function in participants with knee OA over 24 weeks. METHOD: Randomized, double-blind, placebo-controlled clinical trial with 3 groups: PRP (n = 20), plasma (n = 21) and saline (n = 21). Two ultrasound-guided knee injections were performed with a 2-week interval. The primary outcome was visual analog scale 0-10 cm (VAS) for overall pain at week 24, with intermediate assessments at weeks 6 and 12. Secondary outcomes were: pain at rest, pain at movement, physician and patient\'s global assessment, likert scale for improvement, WOMAC (Western Ontario McMaster Universities Osteoarthritis Index), KOOS (Knee Injury and Osteoarthritis Outcome Score), OMERACTOARSI criteria and Timed Up and Go Test. RESULTS: Baseline characteristics were similar between groups: 57 (92%) of participants were female, with a mean age of 65 years, mean body mass index of 28.0 Kg/m2 and mean VAS for overall pain at baseline of 6.2 cm. Changes from baseline for VAS for overall pain at week 24 were -2.9 (SD 2.5), -2.4 (SD 2.5) and -3.5 (SD 3.3) cm for PRP, plasma and saline, respectively (p intergroup = 0.499). At weeks 6 and 12 there was also no difference between the groups. Similarly, there was no difference between groups regarding secondary outcomes, except for the likert scale for improvement, in which there was a significant difference in the PRP group between weeks 6 and 12, suggesting better responses at week 12 (p = 0.003). Adverse events occurred in 13 (65%) participants in the PRP group, 5 (24%) in the plasma group and 7 (33%) in the saline group (p = 0.02), most common mild to moderate pain with a mean duration of 2 days, but without difference between groups regarding type, intensity and duration of symptoms. CONCLUSIONS: PRP and plasma were not superior to placebo for pain and function improvement in participants with knee OA over 24 weeks. The PRP group had a higher frequency of adverse events, but type, intensity and duration were not different between groups

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

Introdução: Os corticosteroides intra-articulares (IA) são amplamente utilizados no tratamento da osteoartrite (OA) de joelho, porém é desconhecido qual dentre estes agentes é o mais eficaz. Objetivo: O objetivo do presente estudo foi comparar a eficácia das infiltrações IA de triancinolona hexacetonida (TH) e de acetato de metilprednisolona (AM) na OA de joelho. Pacientes e Métodos: Pacientes com OA sintomática de joelho, graus II ou III de Kellgren-Lawrence, foram randomizados para receber uma única infiltração IA com 40mg de TH ou AM. As avaliações clínicas foram realizadas nas semanas 4, 12 e 24. O desfecho primário do estudo foi a melhora da dor do joelho pelo paciente por escala visual analógica (EVA) da visita basal à semana 4. Os desfechos secundários incluíram a avaliação global da doença pelo paciente e pelo médico, o questionário de osteoartrite Western Ontario and McMaster Universities (WOMAC), o índice de Lequesne e o critério de resposta Outcome Measures in Rheumatology and Osteoarthritis Research Society International (OMERACT-OARSI). Na análise estatística, foram empregadas equações de estimativa generalizada, com estatística de Wald para contrastes do tipo 3 e ajustes de Tukey-Kramer para comparações múltiplas. Resultados: Cem pacientes foram incluídos na população com intenção de tratar, 50 em cada braço do estudo. Uma melhora significativa na dor pela EVA foi observada na semana 4 para ambos os grupos (P < 0,0001), não havendo diferença entre eles (P=0,352). Esta melhora foi sustentada até a semana 24. Uma melhora significativa em relação à avaliação basal foi observada na avaliação global da doença pelo paciente e pelo médico, no questionário WOMAC e no índice de Lequesne, não havendo diferença entre os grupos. A melhora nos desfechos secundários de avaliação foi sustentada durante o estudo, exceto para a avaliação global da doença pelo paciente. O critério de resposta OMERACT-OARSI foi alcançado por 74% e 72% dos pacientes dos grupos TH e AM, respectivamente. Conclusão: TH e AM são igualmente eficazes na OA de joelho, e a melhora na dor e na função física pode ser sustentada por até 24 semanas Introduction: Intra-articular (IA) corticosteroid injections are broadly used in the treatment of knee osteoarthritis (OA), but it is unknown which of these agents is the most effective. Objective: The aim of the present study was to compare the efficacy of triamcinolone hexacetonide (TH) and methylprednisolone acetate (MA) IA injections in knee OA. Patients and Methods: Patients with symptomatic knee OA, Kellgren-Lawrence grades II or III, were randomized to receive a single IA injection with 40mg of TH or MA. Evaluations were performed at 4, 12 and 24 weeks. The primary outcome of the study was to evaluate the improvement in the patient\'s knee pain by visual analogue scale (VAS) from baseline to week 4. Secondary outcomes included the global assessment of the disease by the patient and the physician, the Western Ontario and McMaster Universities osteoarthritis questionnaire (WOMAC), the Lequesne index and the Outcome Measures in Rheumatology and Osteoarthritis Research Society International (OMERACT-OARSI) criteria of response. Generalized estimating equations with Wald statistics for type 3 contrasts and Tukey-Kramer multiple comparison adjustment were employed in statistical analysis. Results: The intention-to-treat population included one hundred patients; 50 in each study arm. A significant improvement in pain by VAS was observed at week 4 for both groups (P