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OBJETIVO: Avaliar a efetividade das orientações para higiene do sono em mulheres portadoras de fibromialgia. MATERIAIS E MÉTODOS: Setenta mulheres completaram o estudo. Na avaliação foram aplicados o Questionário de Impacto da Fibromialgia(FIQ), o Índice de Qualidade do Sono de Pittsburgh (PSQI) e um questionário geral, com dados pessoais e informações de hábitos de vida. Todas as pacientes receberam informações quanto à doença, além de um diário do sono, e apenas o grupo-experimental recebeu orientações para higiene do sono. Foi solicitado às pacientes que realizassem a higiene do sono, e as mesmas foram reavaliadas após três meses. RESULTADOS: A idade média das pacientes do grupo-controle foi 55,2 ± 7,12 anos, e a do grupo-experimental foi 53,5 ± 8,89 anos (P = 0,392). Nessas pacientes foram observadas diminuições da medida de Escala Visual Analógica de dor (P = 0,028), de cansaço (P = 0,021) e do componente 1 do PSQI (P = 0,030). O grupo que recebeu orientações para higiene do sono mostrou redução significativa na dificuldade de retorno ao sono quando acordava de madrugada (P = 0,031). O grupo-experimental apresentou aumento na porcentagem de relatos de ambiente sem ruído (variando de 42,9% para 68,6%), diminuição da porcentagem de relatos de ambiente com pouco ruído (variando de 40% para 22,9%) e diminuição na porcentagem de relatos de ambiente com muito ruído (variando de 17,1% para 8,6%). As alterações facilitaram o retorno ao sono quando as pacientes acordavam durante a madrugada. CONCLUSÃO: Uma cartilha com orientações de higiene do sono permitiu a alteração do comportamento das pacientes, que obtiveram melhora da dor e do cansaço, aumento da qualidade subjetiva do sono, além de facilitação do retorno ao sono após despertar durante a madrugada. OBJECTIVE: To evaluate the effectiveness of sleep hygiene instructions for women with fibromyalgia. MATERIALS AND METHODS: Seventy women with fibromyalgia completed the study. The assessment comprised the Fibromyalgia Impact Questionnaire (FIQ), the Pittsburgh Sleep Quality Index (PSQI), and a general questionnaire with personal data and lifestyle information. All patients received information about the disease and a sleep diary, but only the experimental group received the sleep hygiene instructions. Patients were asked to practice sleep hygiene, and, after three months, they were reevaluated by use of the same questionnaires. RESULTS: The mean age in the control group was 55.2 ±7.12 years, and, in the experimental group, 53.5 ±8.89 years (P = 0.392). The experimental group showed: a decrease in the pain Visual Analogue Scale values (P = 0.028), in fatigue (P = 0.021), and in the PSQI component 1 (P = 0.030); and a significant reduction in the difficulty falling asleep after waking up in the middle of the night (P = 0.031). The experimental group also showed an increase in the reporting percentage of silent environment (ranging from 42.9% to 68.6%), a decrease in the reporting percentage of fairly quiet environment (ranging from 40% to 22.9%), and a decrease in the reporting percentage of noisy environment (ranging from 17.1% to 8.6%). These changes facilitated falling asleep after waking up in the middle of the night. CONCLUSION: The sleep hygiene instructions allowed changing the patients' behavior, which resulted in pain and fatigue improvement, increased subjective quality of sleep, in addition to facilitating falling asleep after waking up in the middle of the night. Universidade Federal de São Paulo (UNIFESP) Universidade de São Paulo Faculdade de Medicina King's College of London Division of Neuroscience Department of Physiology UNIFESP, EPM, São Paulo SciELO

Fibromyalgia (FM) is a syndrome that can be associated with several rheumatic diseases. However, no study has evaluated its frequency in patients with primary antiphospholipid syndrome (PAPS). The objective of this study was to analyze the frequency of FM in PAPS patients compared with healthy controls, to determine the possible associations between FM and PAPS features, and also to evaluate quality of life and depression in these patients. This case–control study included 30 PAPS patients (by the Sapporo criteria) and 40 healthy subjects. Demographic and clinical data, drug use, and antiphospholipid antibodies were analyzed. FM was diagnosed based on international criteria (ACR). Questionnaires on quality of life, including the Short Form 36 Health Survey (SF-36), Beck Depression Inventory (BDI), Fibromyalgia Impact Questionnaire (FIQ), and Visual Analog Scale (VAS), were also applied. PAPS patients and controls were similar in mean age as well as in distributions of gender and Caucasian race. Mean disease duration was 5.4 ± 4.2 years. A diagnosis of fibromyalgia was made in five (16.7%) PAPS patients and no controls ( p = 0.012). PAPS patients had more diffuse pain (53% vs. 0%, respectively, p

This report considers the rare situation in which primary antiphospholipid syndrome (PAPS) is linked with thrombotic thrombocytopenic purpura (TTP). It describes the case of a young lady with PAPS, characterized by recurring cerebro-vascular abnormalities and marked livedo reticularis, combined with circulating anticardiolipin and lupus anticoagulant antibodies. On follow-up, while on oral anticoagulation, she developed severe thrombocytopenia associated with hematuria, microangiophatic anaemia and neurological manifestations consistent with a diagnosis of TTP. The patient was treated with pulses of methylprednisolone and plasmapheresis with plasma exchange. The result was a favourable outcome. To our knowledge, this is the seventh report on this rare association in the English-language literature of this field.

The Behçet's Disease Current Activity Form (BDCAF) is a clinical instrument used to assess the activity of Behçet's disease (BD), which was originally developed in English. The aim of the present study was to perform a cross-cultural adaptation of the BDCAF to Brazilian Portuguese language and to evaluate its reliability in a population of Brazilian patients with BD. Brazilian Portuguese version of the BDCAF, named BR-BDCAF, was obtained according to established guidelines. Forty Brazilian patients with BD diagnosed according to the International Study Group for Behçet's Disease criteria were assessed by two rheumatologists in independent sessions and submitted to the BR-BDCAF. Inter- and intraobserver agreement were then evaluated by kappa scores (values higher than 0.6 indicated good agreement). Good inter- and intraobserver agreements were achieved for the most common manifestations of BD: kappa scores higher than 0.6 were obtained for oral and genital ulcerations, skin lesions, and articular and general complaints. Moderate interobserver agreement was obtained for ocular activity (kappa 0.483) and fair interobserver agreement was obtained for gastrointestinal (kappa 0.322), major vessel (kappa 0.281), and central nervous system activity (kappa 0.304). BR-BDCAF was found to be a reliable instrument for the classic mucocutaneous and articular manifestations of BD and for general complaints, but complementary assessment is needed to evaluate specific visceral involvement for disease activity.

BACKGROUND: Fibromyalgia is a rheumatic syndrome characterized by widespread chronic musculoskeletal pain and specific palpable tender points. It is often associated with generalized fatigue, sleep disturbances, morning stiffness, dyspnea, anxiety and mood disturbances that may evolve into depression. Thus, such individuals' quality of life is negatively affected. However, the discriminating power of quality-of-life and depression assessment instruments is still unknown. OBJECTIVE: To assess depression and quality of life among patients with fibromyalgia, and the discriminating power of such instruments. METHOD: Quality of life was assessed by one specific instrument, the Fibromyalgia Impact Questionnaire (FIQ), and another generic one, the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). The Beck Depression Scale (BDS) was used to assess depression. Forty women participated: 20 with fibromyalgia (test group) and 20 healthy women (control group). The three protocols were applied to all individuals in both groups in a single evaluation session. All statistical analyses were performed using Student's t-test, with a = 0.05. RESULTS: Statistically significant differences between test and control groups were found via all questionnaires (p

There are common findings between Behcet’s disease (BD) and celiac disease (CD); however, association in the same patient is a rarity. We relate the third case in the literature of this overlap in a 40-year-old woman with history of obstipation since her childhood. She also presented asymmetric polyarthralgia, loss of weight, anemia, oral recurrent aphthas (>3/year) and genital ulcerations, inflammatory lower back pain, bowel bleeding and abdominal colic. Afterwards, she presented episodes of erythema nodosum, superficial thrombophlebitis, pseudofolliculitis and aseptic meningitis, thus fulfilling criteria for BD. Due to persistence of the digestive complaints, a gastrointestinal endoscopy was performed. The biopsy showed chronic duodenitis with intraepithelial lymphocytosis, crypt hyperplasia, and villous atrophy. Endomysial antibody was positive. She fulfilled the diagnosis criteria for CD; a gluten-free diet was applied with clinical improvement. Ascertaining whether pathogenic mechanisms are common in these two conditions requires further investigation.

We described a pilot study using Video capsule endoscopy (VCE) aiming the assessment of small bowel in Behçet's disease (BD). Ten patients with BD and abdominal complaints underwent VCE with Given Pillcam SB (Given Imaging Ltd., Yoqneam). VCE revealed small bowel lesions in all ten subjects. Five patients had active symptoms of BD while five others had clinically inactive disease. Jejune was the most frequently affected GI segment being involved in eight cases, four from each group. We suggest that small bowel involvement may be frequent in BD patients, even in the absence of oral ulcerations.

The objective of this study was to analyze the clinical, laboratorial, and therapeutical response of polymyalgia rheumatica (PMR) to anti-tumor necrosis factor (anti-TNF) treatment. We systematically searched English articles on the subjects of PMR who were treated with TNF blockers in Pubmed from 1994 to 2010. In addition, we reported on two patients with PMR who were treated by the Rheumatology Division of the Hospital das Clinicas da Faculdade de Medicina da Universidade in Sao Paulo, Brazil. Ninety-nine cases of patients with PMR treated with anti-TNF were reviewed. The age of these patients ranged from 63 to 84 years, and 70.7% of them were female. Disease duration varied from 10.5 weeks to 95 months, and time of follow-up varied from 2 weeks to 21 months. Infliximab was the anti-TNF of choice in three studies, while etanercept was in five. Time to response varied from 2 to 8 weeks. After anti-TNF treatment, prednisone reduction was observed in all studies. Clinical improvement was found in 7/7 studies, and laboratory improvement of at least 50% of inflammatory markers was observed in 6/7 studies. This study demonstrated a good clinical and laboratory response to anti-TNF therapy in patients with PMR, with or without glucocorticoid.

INTRODUCTION: Personality traits have been associated with primary depression. However, it is not known whether this association takes place in the case of depression comorbid with fibromyalgia. OBJECTIVE: The authors investigated the association between a current major depressive episode and temperament traits (e.g., harm avoidance). METHOD: A sample of 69 adult female patients with fibromyalgia was assessed with the Temperament and Character Inventory. Psychiatric diagnoses were assessed with the Mini-International Neuropsychiatric Interview severity of depressive symptomatology with the Beck Depression Inventory, and anxiety symptomatology with the IDATE-state and pain intensity with a visual analog scale. RESULTS: A current major depressive episode was diagnosed in 28 (40.5%) of the patients. They presented higher levels of harm avoidance and lower levels of cooperativeness and self-directedness compared with non-depressed patients, which is consistent with the Temperament and Character Inventory profile of subjects with primary depression. However, in contrast to previous results in primary depression, no association between a major depressive episode and self-transcendence was found. CONCLUSIONS: The results highlight specific features of depression in fibromyalgia subjects and may prove important for enhancing the diagnosis and prognosis of depression in fibromyalgia patients.

Recebido em 06/10/2009. Aprovado, apos revisao, em 24/11/2009. Roberto Ezequiel Heymann e Eduardo dos Santos Paiva declaram ter recebido honorarios da Lilly, Janssen-Cilag, Boehringer, Apsen e Pfizer para palestras e consultoria; Milton Helfenstein Junior recebeu honorarios da Pfizer e Merck Sharp para palestras e consultoria; Daniel Feldman Pollak recebeu honorarios da Lilly, Pfizer e Merck Sharp; Jose Eduardo Martinez recebeu honorarios da Sanofi Aventis para palestras e da Pfizer para palestras e consultoria; Jose Roberto Provenza recebeu honorarios dos laboratorios Roche, Bristol, Ache e Pfizer para participar de pesquisas clinicas com novos farmacos na PUC-Campinas; Marcelo Cruz Rezende declara ter recebido honorarios da Lilly-Boehringer para a participacao em simposios e da Pfizer para ser palestrante e participar de simposios; valerio valim Cristo declara recebimento de honorarios por apresentacao, conferencia ou palestra pela Roche, alem de financiamento para a realizacao de pesquisa, organizacao de atividade de ensino ou comparecimento a simposios pela Lilly, Genzyme, Schering-Plough. os demais autores declararam nao haver conflitos de interesse.1. Coordenador do Ambulatorio de Fibromialgia da UNiFESP e assistente doutor da Disciplina de Reumatologia da UNiFESP2. Professor Assistente da Disciplina de Reumatologia, UFPR. Chefe do ambulatorio de fibromialgia do HC-UFPR3. Assistente doutor da Disciplina de Reumatologia da UNiFESP4. Professor Adjunto da Disciplina de Reumatologia da UNiFESP e chefe do Setor de reumatismos de partes moles da UNiFESP5. Professor titular do Departamento de Medicina da PUC-SP, doutor em Reumatologia pela UNiFESP e diretor da Faculdade de Medicina da PUC-SP6. Professor titular de Reumatologia da PUC-Campinas e chefe do Servico de Reumatologia do Hospital Universitario da PUC-Campinas7. Professora orientadora da pos-graduacao da Faculdade de Ciencias da Saude da UnB e chefe do centro de ambulatorios do Hospital Universitario de Brasilia8. Membro da Sociedade Brasileira de Reumatologia9. Mestre em Medicina pelo instituto de Ensino e Pesquisa da Santa Casa de Belo Horizonte, coordenador do Programa de Residencia Medica em Reumatologia e do Ambulatorio de Fibromialgia da Santa Casa de Belo Horizonte10. Ex-presidente da Sociedade Brasileira de Reumatologia, bienio 2007-200811. Professora colaboradora da Faculdade de Medicina da USP, assistente doutora do Servico de Reumatologia e responsavel pelo ambulatorio de Fibromialgia do Servico de Reumatologia do HC-FMUSP12. Responsavel pelo Setor de Reumatologia e Preceptor do programa de Residencia em Clinica Medica da Santa Casa de Campo Grande. Ex-presidente da Sociedade de Reumatologia do Mato Grosso do Sul13. Professor assistente de Reumatologia da Universidade Federal de Ciencias da Saude de Porto Alegre (UFCSPA) e mestre em Clinica Medica pela UFGRS14. Reumatologista com especializacao em Medicina Esportiva do setor de reabilitacao, procedimentos e coluna vertebral pela UNiFESP15. Ex-fellow da Universidade da virginia (EUA), mestre em Educacao e Ciencia e professora da UNiSUL16. Professora adjunto do Departamento de Clinica Medica, chefe do ambulatorio de fibromialgia e chefe do servico de Reumatologia do Hospital Universi-tario da Universidade Federal do Espirito Santo17. Doutora em Reumatologia pela UNiFESP, membro da Sociedade Brasileira de Reumatologia e da Sociedade Brasileira de Clinica Medica18. Membro da Sociedade Brasileira para o Estudo da Dor19. Presidente da Associacao Brasileira de Medicina Fisica e Reabilitacao, professora colaboradora da Faculdade de Medicina da Universidade de Sao Paulo e doutora em Medicina pela FMUSP20. Membro da Associacao Brasileira de Medicina Fisica e Reabilitacao21. Professor titular de Neurologia da Universidade Federal Fluminense (UFF), coordenador do Departamento de Dor da Academia Brasileira de Neurologia (ABN) e do Subcomite de Dor da European Neurological Society (ENS). Membro da Peripheral Nerve Society22. Doutor em ortopedia e Traumatologia pela Faculdade de Medicina da USP, medico Assistente do Grupo de Mao e professor colaborador da FMUSP23. Membro da Sociedade Brasileira de ortopedia e Traumatologia24. Membro da Consultoria Axia.Bio farmacoeconomia e pesquisa em saude25. Diretor executivo do Nucleo de Gestao de Pesquisas da UNiFESP, mestre em Ciencias pela UNiFESP e socio-pesquisador da Axia.Bio

To describe clinical and epidemiological data of Behçet's disease (BD) in Brazil, we retrospectively reviewed records of all patients seen between 2006 and 2007 at the BD outpatient clinic of University of Sao Paulo. One hundred and six patients fulfilled the International Study Group for Behçet's Disease diagnostic criteria and they were included in this study. There was a female/male ratio of 2.2:1 and mean age at diagnosis was 31.9 +/- 9.2 years. In order of frequency, oral (100%) and genital ulcerations (92.5%), pseudofolliculitis (59.4%), erythema nodosum (49.1%), ocular lesions (47.2%), and musculoskeletal complaints (35.8%) were the most common manifestations. Blindness and major vessel involvement (18.2% vs. 5.5%, p = 0.038 and 27.3% vs. 9.6%, p = 0.019) were more frequent among male than female patients. We concluded that in Brazil, a South American country faraway from the Silk Route, BD follows the same pattern exhibited on its usual endemic area.

This study aimed to verify whether techniques of yoga with and without the addition of Tui Na might improve pain and the negative impact of fibromyalgia (FMS) on patients' daily life.Forty (40) FMS women were randomized into two groups, Relaxing Yoga (RY) and Relaxing Yoga plus Touch (RYT), for eight weekly sessions of stretching, breathing, and relaxing yogic techniques. RYT patients were further submitted to manipulative techniques of Tui Na.Outcome measures comprised the Fibromyalgia Impact Questionnaire (FIQ), pain threshold at the 18 FMS tender points, and a verbal graduation of pain assessed before treatment and on the followup. The visual analog scale (VAS) for pain was assessed before and after each session and on the follow-up.Seventeen (17) RYT and 16 RY patients completed the study. Both RY and RYT groups showed improvement in the FIQ and VAS scores, which decreased on all sessions. The RYT group showed lower VAS and verbal scores for pain on the eighth session, but this difference was not maintained on the follow-up. Conversely, RY VAS and verbal scores were significantly lower just on the follow-up.These study results showed that yogic techniques are valid therapeutic methods for FMS. Touch addition yielded greater improvement during the treatment. Over time, however, RY patients reported less pain than RYT. These results suggest that a passive therapy may possibly decrease control over FMS symptoms.

INTRODUCTION: Previous studies have detected the presence of anti-endothelial cell antibodies (AECA) in patients with Behçet's disease (BD). However, no real evidence exists whether these antibodies exert any influence on clinical presentation and/or activity of this disease. OBJECTIVES: To determine the frequency of AECA in patients with BD and analyze possible clinical associations. METHODS: 50 patients with BD who fulfilled diagnostic criteria were selected. Thirty-seven patients were females, and 13 were males; the mean age was 44 ± 9 years with a mean follow-up time of 10 ± 7.5 years. AECA were assayed by ELISA using ECV-304 cells as the antigenic substrate. The prevalence of AECA was determined, and their possible relationships with present and past clinical features were investigated. RESULTS: AECA were detected in the sera of 38% of the patients (IgG in 13, IgM in four, and IgG plus IgM in two). An association was observed between AECA and a previous history of central nervous system involvement (OR= 5.4, p= 0.03). This association was more evident for IgG-AECA (OR= 6.0, p= 0.02). A trend of an increased risk of aneurysms was also observed in patients with IgG-AECA (OR= 2.58, p= 0.77). None of the other clinical characteristics showed a relevant association with these antibodies. CONCLUSION: Our data suggest that IgG-AECA may be a marker of more severe lesions in patients with BD based on the higher frequency of previous central nervous system manifestations in patients who presently display circulating AECA. INTRODUÇÃO: Estudos anteriores detectaram a presence de anticorpos anti-célula endotelial (AACE) em pacientes com doença de Behçet, porém não há nenhuma evidência se a presença destes anticorpos exerce alguma influência na apresentação clínica ou atividade da doença. OBJETIVOS: Determinar a freqüência de AACE em pacientes com doença de Behçet e analisar possíveis associações clínicas. MÉTODOS: Foram selecionados 50 pacientes que preencheram corretamente os critérios diagnósticos para a doença de Behçet. Trinta e sete pacientes eram do sexo feminino e 13 do sexo masculino, média de idade de 44 ± 9 anos e tempo médio de seguimento de 10 ± 7,5 anos. O AACE foram analisados por ELISA utilizando células ECV-304 como substrato antigênico. A prevalência de AACE foi determinada e foram investigadas possíveis relações com características clínicas atuais e pregressas. RESULTADOS: Os AACE foram detectados no soro de 38% dos pacientes (13 na forma IgG, 4 IgM e 2 nas formas IgG e IgM). Observamos uma associação entre o AACE e história pregressa de envolvimento de sistema nervoso central (OR=5,4; p=0,03). Esta associação era mais evidente para o AACE na forma IgG (OR=6,0; p=0,02). Observamos também uma tendência de risco aumentado de aneurismas em pacientes com AACE na forma IgG (OR=2,58; p=0,77). Nenhuma outra característica clínica mostrou-se relevante com o anticorpo estudado. CONCLUSÃO: Nossos dados sugerem que o AACE na forma IgG pode ser uma marcador de lesão mais grave em pacientes com doença de Behçet baseado no fato de encontrarmos uma maior freqüência de história pregressa de manifestação de sistema nervoso central em pacientes com AACE circulante.

CONTEXTO: Auto-eficácia é a crença na habilidade pessoal de desempenhar com sucesso tarefas ou de apresentar comportamentos para produzir um resultado desejável. É conceito-chave para o adequado controle de doenças crônicas e estudos sobre o tema são incipientes no Brasil. OBJETIVO: Avaliar a crença de auto-eficácia de pacientes com dor crônica e relacioná-la a variáveis sociodemográficas, de características da dor e à presença de sintomas depressivos. MÉTODOS: A amostra, de conveniência, foi de 132 sujeitos. Os instrumentos utilizados foram a Escala de Auto-Eficácia para Dor Crônica (AEDC) e o Inventário de Depressão de Beck (IDB). RESULTADOS: O escore médio de auto-eficácia foi 170,8 (DP = 56,7). Auto-eficácia menor foi observada nos pacientes com até 8 anos de escolaridade, quando comparada à de pacientes com escolaridade entre 9 e 11 anos (p = 0,015). Auto-eficácia mais elevada foi observada nos doentes com dor menos intensa (p = 0,042). A Escala AEDC apresentou correlação negativa com o IDB (r = - 0,48; p < 0,01). CONCLUSÕES: Os doentes com escolaridade de até 8 anos apresentaram auto-eficácia menor que os doentes que tinham entre 9 e 11 anos de escolaridade. Os pacientes com dor menos intensa e os doentes com menos sintomas depressivos apresentaram maior auto-eficácia. BACKGROUND: Self-efficacy is the belief about one’s personal ability to perform a task or specific behavior successfully. Self-efficacy is a key concept to manage chronic diseases and the studies about it are insufficient in Brazil. OBJECTIVE: To evaluate chronic pain patient’s self-efficacy belief and relate to social demographic variables, pain and depressive symptoms. METHODS: The convenience sample was 132 subjects. The instruments utilized were Chronic Pain Self-efficacy Scale (CPSS) in Portuguese version (AEDC) and Beck Depression Inventory (BDI). RESULTS: The self-efficacy average score was 170.8 (DP = 56.7). Low self-efficacy was observed in 8 year education level patients compared to 9 to 11 year education level (p = 0.015). Higher self-efficacy was observed in patients with lower pain intensity (p = 0.042). The AEDC was negative correlated to IDB depression (r = - 0.48; p < 0.01). CONCLUSIONS: Patients with 8 year education level showed low self-efficacy than patients with 9 to 11 year education level. Subjects with lower pain intensity and fewer depressive symptoms showed higher self-efficacy scores.

To characterize and quantify the sleep complaints of patients with fibromyalgia (FM) using the Pittsburgh Sleep Quality Index (PSQI).The PSQI was applied to 30 patients with FM according to American College of Rheumatology classification criteria and to 30 healthy controls in individual sessions under similar conditions.The median global PSQI scores were [median (25-75%)] 12.0 (10-16) and 3.0 (2.0-5.0) in patients with FM and controls, respectively (p0.001). All PSQI component scores except sleep medications were significantly higher in patients than controls. Sleep latency, sleep disturbances, and daytime dysfunction were the most frequent sleep difficulties experienced by patients with FM.Our results indicate that the PSQI is a useful instrument for characterizing and quantifying sleep disturbances in patients with FM.

Relatamos aqui o caso de um paciente masculino de 30 anos de idade, sexo masculino, com achados clinicos tipicos da sindrome de Behcet (SB) e da policondrite recidivante (PR) sem, no entanto, preencher completamente os criterios de classificacao para nenhuma das entidades isoladamente. O termo sindrome MAGIC (Mouth And Genital ulcers with Inflamed Cartilage) tem sido usado para classificar pacientes semelhantes. Uma breve revisao dos casos previamente relatados tambem e apresentada.

OBJETIVO: Desenvolver uma versão transcultural do Fibromyalgia Impact Questionnaire (FIQ) para a população brasileira e analisar sua validade e eficácia quando aplicado em pacientes com fibromialgia. PACIENTES E MÉTODOS: Participaram do estudo 44 pacientes com fibromialgia (FM), diagnosticados segundo os critérios do American College of Rheumatology (ACR), 1990. Baseados nas orientações de Guillemin et al(22), foram convidados quatro professores de língua inglesa, um reumatologista e dois fisioterapeutas. O procedimento seguiu as etapas: tradução inicial por dois professores de inglês, avaliação das duas traduções para uma versão única, versão para a língua inglesa por dois professores de inglês nativos, reunião de consenso com dois professores de inglês, reumatologista e fisioterapeutas para versão teste, avaliação da equivalência cultural, versão final, avaliação da confiabilidade e reprodutibilidade. A versão teste foi aplicada em 20 pacientes com FM, tendo em todas as questões o item "não-aplicável". Substituição de possíveis questões com mais de 15% de respostas "não-aplicável" por outras de mesmo conceito, resultando na versão final. Aplicação dessa versão em 24 pacientes com FM por dois avaliadores que fizeram a entrevista no mesmo dia com intervalo de uma hora e, após um período de sete dias da primeira avaliação, o questionário foi reaplicado pelo primeiro avaliador. RESULTADOS: Na aplicação da versão teste não houve questões com mais de 15% de respostas "não-aplicável". Sendo assim, não foi mudado o texto para a versão final. Porém, houve dificuldade de compreensão das escalas visuais analógicas (questões 4 a 10). Com isso, foram acrescidas "carinhas" nos dois extremos: à esquerda uma "carinha" feliz e à direita, uma infeliz. Esse processo deu origem à versão final. Na avaliação da confiabilidade, os resultados do avaliador 1 (primeira e segunda aplicação) e do avaliador 2 foram comparados, bem como as duas aplicações do avaliador 1. Ambas demonstraram que não houve diferença entre os dois avaliadores no que diz respeito a aplicação do questionário. A comparação entre os avaliadores foi feita com base nas médias globais. Os valores de p foram todos superiores a 10%, indicando que não houve evidência de diferenças significantes entre aplicações dos questionários nos mesmos pacientes. CONCLUSÃO: A versão brasileira do FIQ, o QIF, mostrou ser um instrumento válido e confiável para medir a capacidade funcional e o estado de saúde de pacientes brasileiros com FM. OBJECTIVE: To develop a cross-cultural validation of the Fibromyalgia Impact Questionnaire (FIQ) to the Brazilian population and to analyze its validity and efficacy when applied to fibromyalgia patients. PATIENTS AND METHODS: Forty-four fibromyalgia patients classified following the 1990 American College Rheumatology (ACR) criteria. According to the 1993 Guillemin et al(22) guidelines, four English teachers, one rheumatologist and two physical therapist were invited to participate. The procedure was established according to the following steps: initial translation by two English teachers, evaluation of these two translations to a unique version, back translation to English by two native teachers, a consensus meeting where there were two English teachers, one rheumatologist and physiotherapists for the test-translation, evaluation of cultural equivalency, final version, reliability and reproducibility. The test-translation has been applied to 20 fibromyalgia patients, having in all questions the item "not applicable". Questions answered as "not applicable" by 15% or more patients were reformulated, resulting in the final version. Application of the final version to 24 fibromyalgia patients by two different interviewers who applied the final questionnaire in the same day, with one hour interval and seven days after the first interview, the questionnaire was re-applied by the first interviewer. RESULTS: During the application of the test-version none of the questions were answered as "not applicable" for 15% or more. Consequently, the text was not reformulated. However, there were some difficulty for understanding the visual analogic scales (questions 4 to 10). As a result, "small faces" were added in both ends: a "happy face" to the left and a "sad face" to the right. The evaluation of reliability and reproducibility obtained by the first interviewer (between the first and second application) as well as results obtained by the second interviewer were compared. Both showed no difference among the two interviewers in what concerns the questionnaire application. The p values were above 10% indicating no significant difference between questionnaires application. CONCLUSION: The FIQ Brazilian version, QIF, showed to be a reliable and valid instrument to measure the functional ability and the health state of Brazilian fibromyalgia patients.

INTRODUCTION AND OBJECTIVE: The aim of this study was to review the literature concerning of the prevalence of fibromyalgia in general population using the criteria from the American College of Rheumatology (ACR). METHODS: The literature envolved the period of 1990 to 2005, in the databases Medline, Lilacs, Embase and ISI. The keywords "fibromialgia" and "prevalencia" and the correspondents in English "fibromyalgia" and "prevalence" had been used. It was selected 97 articles and after reading the summaries, the ones related to the fibromyalgia prevalence with oher diseases were excluded. Only 30 articles evoked the subject prevalence of the fibromyalgia in the population. The selected articles were grouped in five items: a) the prevalence of fibromyalgia in adult populations; b) prevalence of fibromyalgia in women; c) prevalence of fibromyalgia in children and adolescents; d) prevalence of fibromyalgia in specific populations; e) prevalence of chronic and diffuse pain in the population according to the ACR criteria. RESULTS: Literature points that the prevalence of fibromyalgia in the general population has values between 0,66 and 4,4%, being more prevalent in women than in men, especially in individuals aged between 35 to 60 years. Studies involving children, adolescents or other special groups are few or inconclusive. The prevalence of chronic and diffuse pain in general population althoug rarily been studied points to values between 11 and 13%. CONCLUSION: More studies on prevalence of chronic and diffuse pain must be stimulated, as well as the ones concerning prevalence in the adult population, children and young.

As limitacoes dos tratamentos convencionais tem levado os pacientes com fibromialgia (FM) a optarem por muitas abordagens alternativas e complementares e, dentre estas, a ioga pode ser uma opcao. Torna-se importante para o especialista da area conhecer os potenciais beneficios desta modalidade como recurso complementar no tratamento da FM.

A gravidez e uma condicao fisiologica na qual ocorrem varias mudancas imunoendocrinas com a finalidade de facilitar a imunossupressao e a tolerância aos antigenos paternos e fetais. Na gravidez humana normal existe uma relativa supressao de citocinas tipo Th1 na resposta dos linfocitos, levando a uma prevalencia na resposta do tipo Th2. No LES, onde prevalece a resposta imune do tipo Th2, a gravidez pode estar relacionada com a ativacao da doenca. Este artigo e uma revisao dessas alteracoes relacionadas com a resposta imune durante a gestacao normal e na da paciente com LES.