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Psoriatic arthritis (PsA) is a chronic and systemic immune disease characterized by inflammation of peripheral and/or axial joints and entheses in patients with psoriasis (PsO). Extra-articular and extracutaneous manifestations and numerous comorbidities can also be present. These recommendations replace the previous version published in May 2013. A systematic review of the literature retrieved 191 articles that were used to formulate 12 recommendations in response to 12 clinical questions, divided into 4 sections: diagnosis, non-pharmacological treatment, conventional drug therapy and biologic therapy. These guidelines provide evidence-based information on the clinical management for PsA patients. For each recommendation, the level of evidence (highest available), degree of strength (Oxford) and degree of expert agreement (interrater reliability) are reported.

Spondyloarthritis (SpA) is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. Over some decades, nonsteroidal anti-inflammatory drugs (NSAIDs) have been the basis for the pharmacological treatment of patients with axial spondyloarthritis (axSpA). However, the emergence of the immunobiologic agents brought up the discussion about the role of NSAIDs in the management of these patients. The objective of this guideline is to provide recommendations for the use of NSAIDs for the treatment of axSpA. A panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis of randomized clinical trials for 15 predefined questions. The Grading of Recommendations, Assessment, Development and Evaluation methodology to assess the quality of evidence and formulate recommendations were used, and at least 70% agreement of the voting panel was needed. Fourteen recommendations for the use of NSAIDs in the treatment of patients with axSpA were elaborated. The purpose of these recommendations is to support clinicians’ decision making, without taking out his/her autonomy when prescribing for an individual patient.

The Toronto Psoriatic Arthritis Screen II (ToPAS II) was developed as a tool to screen patients with probable psoriatic arthritis. We aimed to evaluate the validation of the ToPAS II questionnaire in a Brazilian population. The Portuguese translation of the ToPAS II was sent to us by the developer authors of the original index, and adapted to Brazilian Portuguese. Subjects were recruited from dermatology, general, and rheumatology outpatient clinics. After patients completed the questionnaire, they were assessed by a rheumatologist, according to standard protocol. Receiver operating characteristics (ROC) was used to obtain the sensitivity and specificity of the Brazilian Portuguese version of the ToPAS II questionnaire. One hundred and eighty-four subjects were recruited in the study. There were 70 subjects from the psoriasis group, 44 subjects from the psoriatic arthritis (PsA) group, 40 subjects from the rheumatology (non-PsA) group, and 45 healthy controls. Twenty-four patients (34.3%) in the psoriasis group had inflammatory pain and met the CASPAR classification criteria. The area under the ROC curve was 0.96, which indicates that an excellent predictor and optimum cutoff threshold to discriminate patients diagnosed with PsA used was eight as originally chosen. The overall sensitivity and specificity based on the cutoff threshold of eight were 91.3 and 90.9%, respectively. The Portuguese Brazilian version of the ToPAS II has good sensitivity and specificity and is a useful tool to screen for PsA. Key Points • Among these psoriasis patients, almost 35% in fact had psoriatic arthritis without correct diagnosis. Keeping alert of the need to disclose screening tool's use. • The TOPAS II can facilitate the screening of patients suggestive of inflammatory joint disease (with high probability of rheumatologic diagnosis) decreasing morbidity of these patients.

Background. Due to the variety of functions that galectins (Gal) possess, it is clear that they participate in the pathogenesis of rheumatoid arthritis (RA). Although some studies demonstrate their functions, there is still no correlation with the clinical data of the disease, having the physiological meaning still unknown. Objectives. To compare serum levels of Gal-1, -4, and -7 in patients with RA and healthy controls and to correlate them with clinical parameters. Methods. Serum samples were collected from patients with RA and healthy donors to determine the serum levels of Gal-1, -4, and -7. Results. Serum levels of Gal-1, -4, and -7 were significantly higher in RA patients compared to controls. We evaluated disease activity (CDAI) with serum levels of galectins and found that patients who were high in disease activity had high levels of galectin compared to the moderate activity group. Galectin-4 had higher levels in patients who were in high activity when compared to the group in remission or low activity. Evaluating the activity of the individual disease (DAS28), patients in high individual activity had high levels of Gal-4 when compared to the group in remission or low activity. We also found an association between positive rheumatoid factor and Gal-1 and Gal-4 levels. Conclusion. Our results show for the first time the relationship between serum levels of galectin and the clinical parameters of patients with RA. Demonstrating their role in pathogenesis, new studies with galectins are needed to assess how they function as a biomarker in RA.

Although several cytokines and chemokines have been investigated as possible mediators of fibrosis in systemic sclerosis (SSc), specific correlation between cytokines and organ involvement have not been found yet, and a cytokine profile characteristic of SSc is far to be identified. We studied the profile of antifibrotic and profibrotic transcripts involved in skin of SSc patients. The mRNA expression was detected by fluorescence-based quantitative real-time PCR (qPCR) in skin's biopsies from 14 patients with SSc and 5 healthy controls. PDGF-A, CTGF, CCL3, IL-6, IL-13, IL-7, IFNγ, IL-17, IL-22 and RORc were analysed in these samples. CCL3, IL-7, IL-13 and IFN-γ were more expressed in skin's biopsy of patients with SSc (P = 0.0002, P = 0.0082, P = 0.0243, P = 0.0335, respectively) when compared with healthy controls. We also found a positive correlation between CCL3 and IL-7 transcripts (P = 0.0050 r = 0.7187). Furthermore, we observed that patients with lung involvement had lower expression of PDGF-A (P = 0.0385). We found an increase in IL-7, IFN-γ, CCL3 and IL-13 relative mRNA expressions on the skin's biopsy of patients with SSc, and a positive correlation between IL-7 and CCL3. These molecules are involved in the pathogenesis of SSc, and how their interactions occur should be the subject of further studies.

Glucocorticoids (GC) are widely used in the treatment of SSc, although there is not much evidence to prove the benefits offered by these drugs in this disease. In this study, we evaluated the effects of a GC on cytokine production in peripheral blood mononuclear cells (PBMC) of SSc patients. The effect of dexamethasone (DEX) was evaluated in PBMC of 21 SSc patients and 10 healthy volunteers after stimulation of cells with anti-CD3 and anti-CD28. Cytokines IL-2, IL-4, IL-6, IL-10, IL-17A, IL-17F, IFN-γ, TNF, and IL-1β were quantified in the culture supernatant by CBA or ELISA. Of the patients evaluated in this study, 8 (38%) were taking corticosteroids, and esophageal dysfunction was more frequent in these patients when compared to those who did not take corticosteroids. DEX (1.000 nM) treatment in PBMC of SSc patients stimulated with anti-CD3 and anti-CD28 promoted a significant reduction in IL-2, IL-4, IL-6, IL-10, IL-17A, IFN-γ, TNF, IL-1β (p

Systemic sclerosis (SSc) is a rare complex disease characterized by vascular damage, autoimmunity, and extensive skin and internal organs fibrosis. Galectin-3 (Gal-3) is encoded by geneTo investigate associations amongA case-control study with 88 patients and 151 matched controls was performed.TheThe

Introduction Psoriatic arthritis (PsA) is a multifaceted inflammatory disease that can cause joint destruction and impair quality of life. The Psoriatic Arthritis Quality of Life Questionnaire (PsAQoL) was the first disease-specific tool for determining the impact of the disease on the quality of life of people with PsA. Objectives The primary objective was to develop and validate a Brazilian Portuguese version of the PsAQoL. Methods The UK PsAQoL was translated into Brazilian Portuguese using two translation panels. This translation then checked for face validity and construct validity with new samples of patients. Finally, a test-retest validation study was conducted with 52 patients with PsA. The survey included the Nottingham Health Profile (NHP) as a comparator instrument. Results Internal consistency and reproducibility were both excellent for the new adaptation (0.91 and 0.90 respectively Scores on the PsAQoL were found to correlate as expected with the comparator measure and the instrument was able to detect differences in score related to perceived severity of PsA, general health status and presence of a flare. Conclusion The Brazilian PsAQoL was found easy to understand and complete and has excellent reliability and construct validity. The new measure will be a valuable new tool for use in routine PsA practice and clinical trials.

Systemic sclerosis (SSc) is a rare complex disease characterized by vascular damage, autoimmunity, and extensive skin and internal organs fibrosis. Galectin-3 (Gal-3) is encoded by gene LGALS3 (Lectin, Galactoside-Binding, Soluble, 3; 14q22.3) and it has been reported to play a central role in self-tolerance, inflammation, and fibrosis. To investigate associations among LGALS3 single nucleotide polymorphisms (SNPs) and serum levels Gal-3 and SSc susceptibility and their clinical features. A case-control study with 88 patients and 151 matched controls was performed. LGALS3 variants were analyzed by the TaqMan real-time polymerase chain reaction (PCR) system whereas Gal-3 serum levels were measured by sandwich enzyme linked immunosorbent assay (ELISA). Associations among genotypes, clinical features, and Gal-3 levels were performed by univariable and multivariable analysis through statistical packages. The LGALS3 rs4652 A/C genotype was more frequent in SSc patients than controls according to overdominant model [OR 1.89 (CI 95% 1.01 − 3.52); p = .046]. Also, LGALS3 rs4652 C/C polymorphic genotype was associated with lower patient Gal-3 levels (p = .03) and control group (p = 0.005), as noted by generalized linear model (GLM). The LGALS3 rs1009977 G/T controls showed higher Gal-3 levels than wild-type and polymorphic genotypes (p = .03); however, in SSc patients, no difference was found. None of the LGALS3 SNPs or Gal-3 levels was associated with clinical manifestations in SSc patients. Considering only the SSc group, GLM analysis pointed LGALS3 rs4652 and rs2075601, pulmonary arterial hypertension (PAH), myopathy, and health assessment questionnaire (HAQ) and scleroderma health assessment questionnaire (SHAQ) as important predictors for Gal-3 levels. The LGALS3 rs4652 A/C was more frequent in SSc patients and related to lower Gal-3 levels. These findings were corroborated through a GLM to estimate Gal-3 values. Also, by model equations, Gal-3 levels may be predicted by HAQ, SHAQ, PAH, myopathy, and LGALS3 rs4652 and rs2075601 factors. In these ways, we suggest that galectins may be promising biomarkers to identify susceptibility to SSc as well as to identify HAQ, SHAQ, PAH, and myopathy outcomes.

In severe cases of COVID-19, it is important to note that some laboratory signs may alert to the presence of underlying macrophage activation syndrome (MAS), and we ratify that the classic signs of primary MAS are often not present. Here we show a case report of COVID-19 complicated by MAS treated with high doses of methylprednisolone and intravenous Immunoglobulin, with excellent clinical outcome, avoiding orotracheal intubation indeed. The interpretation of laboratory signs leads to early diagnosis and the introduction of effective therapy.

Spondyloarthritis is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. The classification axial spondyloarthritis is adopted when the spine and/or the sacroiliac joints are predominantly involved. This version of recommendations replaces the previous guidelines published in May 2013.A systematic literature review was performed, and two hundred thirty-seven studies were selected and used to formulate 29 recommendations answering 15 clinical questions, which were divided into four sections: diagnosis, non-pharmacological therapy, conventional drug therapy and biological therapy. For each recommendation the level of evidence supporting (highest available), the strength grade according to Oxford, and the degree of expert agreement (inter-rater reliability) is informed.These guidelines bring evidence-based information on clinical management of axial SpA patients, including, diagnosis, treatment, and prognosis.

Systemic sclerosis (SSc) is a multisystemic, complex, and rare disease of connective tissue, with high morbidity and mortality, and without specific treatment. The disease is characterized by three main principles: vascular disease, autoantibody production and inflammation, and fibrosis. Since it is well defined that SSc is characterized by elevated production of TGF-β, IL-6, and IL-1, all of them cytokines related to Th17 differentiation, the hypothesis is that this disease may be strongly related to a polarization of the immune response towards the Th17 pathway. Considering the importance of a better understanding of the pathophysiology of Th17 pathway in SSc, this article aims to propose an update for a better understanding of current knowledge on main cytokines secreted by the Th17 cells (IL-17 A, IL-21, and IL-22) and the future prospects in the current disease.

The objective of the present study was to evaluate the serum levels of soluble oncostatin M (OSM), OSM receptor (sOSMR) and glycoprotein130 (sgp130) in patients with systemic sclerosis (SSc), and the possible associations and correlations with clinical parameters.Serum levels of OSM, sOSMR and sgp130 were evaluated by ELISA in eighty-four SSc patients and eighty-four healthy volunteers.SSc patients had significantly elevated levels of sOSMR and sgp130 when compared with healthy individuals (p0.0001 and p = 0.025, respectively). Diffuse cutaneous SSc and limited cutaneous SSc patients also presented higher levels of sOSMR when compared with healthy individuals (p = 0.003 and p = 0.0001, respectively). Patients with digital ulcers presented higher levels of sOSMR when compared to those without ulcers (p = 0.034). However, sOSMR levels were lower in patients with esophageal dysfunction than patients without this involvement (p = 0.038). OSM levels were undetectable in serum from SSc patients and healthy volunteers.Serum levels of sOSMR and sgp130 are elevated in patients with systemic sclerosis. In addition, associations were observed with important clinical manifestations, suggesting that sOSMR is a candidate biomarker of this disease. More studies are needed to clarify the functions of IL-6 family cytokines in systemic sclerosis.

One of the author’s surname was incorrect. Anderson Ferreira de Almeida should be captured as Anderson Rodrigues de Almeida. The correct name is now presented above.

Although statins have been successfully administered in the treatment of hypercholesterolemia and cardiovascular disease due to their lipid-lowering and anti-atherosclerotic action, they have shown immunomodulatory effects in several studies with immune-mediated diseases. The aim of this study was to investigate the effects of statins treatment on Th1, Th2, and Th17 cytokines production from stimulated peripheral blood mononuclear cells (PBMCs) obtained from Systemic Sclerosis (SSc) patients. We recruited 21 patients classified according to the American College of Rheumatology criteria for SSc for PBMCs culture analysis. Cytokine levels (IL-2, IL-4, IL-6, IL-10, TNF, IFN-γ, IL-17A, and IL-17F) were quantified by ELISA or CBA, and patients were assessed for clinical and exam’s variables. Simvastatin and atorvastatin at 50 μM promoted reduction in all cytokine levels with statistical significance, except for IL-6, which had its reduction only induced by the use of simvastatin. Statins, particularly simvastatin, appear to have an immunosuppressive effect in reducing all cytokine secretion levels from PBMCs of SSc in a dose-dependent manner.

The objective of this study is to assess the serum IL-35 level and its association with clinical manifestations in patients with systemic sclerosis (SSc). IL-35 serum levels were measured by ELISA from 56 patients with SSc and 53 healthy controls. Association of IL-35 serum levels were sought with clinical parameters. Serum IL-35 levels were significantly higher in SSc patients (5.08 ± 0.76 pg/ml) than in healthy individuals (1.89 ± 0.69 pg/ml; p

Background The first autochthonous reports of Chikungunya fever (CF) in Brasil was confirmed in 2014, and by December 2016, there were 263.980 probable cases of CF, 55.03% confirmed. According to recommendations of the Ministry of Health (MH) of Brazil, in an established epidemic situation, the diagnosis of CF should be made by appliyng clinical and epidemiological criteria. There is no indication for the serology for Chikungunya virus (CHIKV) in the acute phase, except in atypical cases and complicated clinical situations, which may generate doubts in clinical practice about the correct diagnosis of these patients. Objectives The objective of this study was to evaluate the concordance of the clinical and epidemiological criteria with the serology results for CHIKV in a cohort of patients with CF. Methods The multicenter cohort CHIKBRASIL from the Northeast of Brazil has enrolled CF patients with joint manifestations since April 2016, using as inclusion criteria the presence of fever and arthralgia/arthritis in a patient residing or who had visited an endemic or epidemic area within 15 days prior to the onset of symptoms. For the present study, we selected patients in which IgM and/or IgG serology was performed, regardless of the results. For the analysis of agreement with the serology, the most characteristic symptoms of CF were used individually (fever, arthritis/arthralgia or exanthema) and three models of association of symptoms were created: (1) fever and arthralgia; (2) fever and arthritis; (3) fever, arthralgia/arthritis, and exanthema. The sensitivity (SENS), specificity (SPEC), positive predictive value (PPV) and negative predictive value (NPV) of the criteria were also assessed, with the serology result considered the gold standard. Results A total of 143 patients were evaluated, 119 (83.2%) of which were female, with a mean age of 53.89 years (± 13.5); 52.4% of the cases were in the subacute phase of the disease (15 days to 3 months) and 42.7% were in the chronic phase (over 3 months). The IgM positivity was observed in 95.1% of cases and IgG in 71.67%. The concordance rate between the IgM serology or combined positive serology (IgM or positive IgG) was over 80% for any of the symptoms/symptoms model analyzed, as well as the SENS and PPV of the symptoms/ symptoms model, which was over 95% in all situations evaluated. The concordance rate for IgG serology ranged from 51.9 to 72.1%. Model 1 presented the highest agreement with the result of positive combined serology. Conclusions During an epidemic situation, the use of clinical and epidemiological criteria shows high agreement with the serology result, regardless of the combination of symptoms presented, with high sensitivity and positive predictive value. Disclosure of Interest None declared

Background Chikungunya fever (CF) is an infectious disease caused by a RNA virus and its transmission occurs by the inoculation of the virus by the female bite of Aedes aegypti mosquito. In Brazil, where the vetor is endemic, the virus rapidly disseminated and there was an epidemic, specially in the Northeast region of the country with 263.980 notified cases in 2016. It is known that CF may have a chronic course with articular symptons, however there is not consistent data in the medical literature on CF evolution in patients with prior rheumatic diseases. Objectives To assess whether there is any difference in the characteristics of articular manifestations of CF in patients with prior inflammatory rheumatic diseases (IRD), non-inflammatory rheumatic diseases (NIRD) and controls (patients with no diagnosed prior rheumatic diseases). Methods Cross-sectional study using a database from CHIKBRASIL cohort. Patients enrolled had clinical and epidemiological characteristics of CF and were classified in three groups: IRD (rheumatoid arthritis, axial spondyloarthritis and systemic lupus erythematosus), NIRD (fibromyalgia and osteoarthritis) and controls (no prior rheumatic diseases). Results A total of 150 patients were enrolled. There were 55 patients with IRD, 40 patients with NIRD and 55 controls, paired by age and sex. There were no differences in acute phase symptoms in the groups. There a was more frequent occurrence of arthritis in patients with IRD compared to NIRD (p=0.001) and to controls (p=0.002). In 89.1% of the patients with IRD there was an underlying disease exacerbation and 74% described an expressive worsening of symptoms compared to the period prior to infection. Patients with IRD had an increase in the current dose of corticosteroids (median 10mg, IQR 10–20) compared to previous dose used (median 6mg, IQR 5–10) after the onset of CF (p=0.0007). Importantly, there was more methotrexate prescription (23.5%) in IRD group, compared to NIRD group (0, p-0.001) and to controls (3.7%, p=0.003). Conclusions Patients with IRD and CF presented significantly more arthritis compared to NIRD or to controls. CF seems to induce underlying rheumatologic disease exacerbation in patients with inflammatory disease and a more aggressive therapeutic approach might be necessary in this group of patients. Disclosure of Interest None declared

Background Chikungunya Fever (CF) is a disease characterized by acute febrile arthritis and caused by a mosquito-transmitted alphavirus. Considering the wide distribution of the vector, the presence of imported cases from 2010 and Brazilian population9s susceptibility, there was a dispersal and establishment of Chikungunya virus (CHIKV) throughout the country. Since 2014, the CF has achieved a large proportion of the Brazilian population and has been responsible for the development of chronic joint symptoms in thousands of people. Objectives To describe the demographic, clinical and serological characteristics of patients from specialized Rheumatology services from northeastern Brazil, in a large, multicenter cohort. Methods Data from 732 patients in a prospective, multicenter, observational cohort conducted in six research rheumatology centers were analyzed. Patients 18 years or older who fulfilled the clinical and epidemiological Health Ministry criteria for case definition of CF were included in the study, from April to December 2016. Results From 732 patients included, 83.1% were women. The mean age was 54.1 (± 13.4) years; 92.4% lived in urban area and 58.6% had only primary education. The most common comorbidities were hypertension (43.8%), hyperlipidemia (25.3%) and diabetes mellitus (13.7%). Prior rheumatologic disease was observed in 16.4% patients, being the most frequent rheumatoid arthritis (32.5%), osteoarthritis (32.5%) and spondyloarthritis (11.7%). Arthralgia was the most frequent symptom referred by all patients; fever and fatigue were also common manifestations, being referred by 95.3% and 87.1% of patients, respectively. Arthritis occurred in 84.3%. The most frequent joint pattern involvement was polyarticular (67.8%) and the additive (84.0%). At the first appointment with the rheumatologist, 75.9% had been or were under corticosteroid use, with the average dose of 15.4 mg (±8.7) of prednisone or equivalent; was observed an median of 8 painfull joints (IQR 4–21) and arthritis was found in 73.6% patients, with an median of 2 swollen joints (IQR 0–5). The median score of patient global assessment at the time of the initial evaluation was 6 (IQR 4–8) using a 10 points visual analogue scale. After resting stiffness was referred by 86.0%, with 58.4% of these longer than 30 minutes. The most commonly prescribed medications were corticosteroids (58.3%) and hydroxychloroquine (59.1%). The serological tests for CHIKV were positive for IgM in 97.1% and for IgG in 71.7% of patients. Conclusions This is the first descriptive study of a cohort Brazilian patients with CF, with an expressive number of patients when compared to those described in the literature. Most of the features of patients in our cohort were similar to the results described in studies/cohorts published. Disclosure of Interest None declared

Chikungunya fever has become a relevant public health problem in countries where epidemics occur. Until 2013, only imported cases occurred in the Americas, but in October of that year, the first cases were reported in Saint Marin island in the Caribbean. The first autochthonous cases were confirmed in Brazil in September 2014; until epidemiological week 37 of 2016, 236,287 probable cases of infection with Chikungunya virus had been registered, 116,523 of which had serological confirmation. Environmental changes caused by humans, disorderly urban growth and an ever-increasing number of international travelers were described as the factors responsible for the emergence of large-scale epidemics. Clinically characterized by fever and joint pain in the acute stage, approximately half of patients progress to the chronic stage (beyond 3 months), which is accompanied by persistent and disabling pain. The aim of the present study was to formulate recommendations for the diagnosis and treatment of Chikungunya fever in Brazil. A literature review was performed in the MEDLINE, SciELO and PubMed databases to ground the decisions for recommendations. The degree of concordance among experts was established through the Delphi method, involving 2 in-person meetings and several online voting rounds. In total, 25 recommendations were formulated and divided into 3 thematic groups: (1) clinical, laboratory and imaging diagnosis; (2) special situations; and (3) treatment. The first 2 themes are presented in part 1, and treatment is presented in part 2. Resumo A febre chikungunya tem se tornado um importante problema de saúde pública nos países onde ocorrem as epidemias. Até 2013, as Américas haviam registrado apenas casos importados quando, em outubro desse mesmo ano, foram notificados os primeiros casos na Ilha de Saint Martin, no Caribe. No Brasil, os primeiros relatos autóctones foram confirmados em setembro de 2014 e até a semana epidemiológica 37 de 2016 já haviam sido registrados 236.287 casos prováveis de infecção pelo chikungunya vírus (CHIKV), 116.523 confirmados sorologicamente. As mudanças ambientais causadas pelo homem, o crescimento urbano desordenado e o número cada vez maior de viagens internacionais têm sido apontados como os fatores responsáveis pela reemergência de epidemias em grande escala. Caracterizada clinicamente por febre e dor articular na fase aguda, em cerca de metade dos casos existe evolução para a fase crônica (além de três meses), com dor persistente e incapacitante. O objetivo deste trabalho foi elaborar recomendações para diagnóstico e tratamento da febre chikungunya no Brasil. Para isso, foi feita revisão da literatura nas bases de dados Medline, SciELO e PubMed, para dar apoio às decisões tomadas para definir as recomendações. Para a definição do grau de concordância foi feita uma metodologia Delphi, em duas reuniões presenciais e várias rodadas de votação on line. Foram geradas 25 recomendações, divididas em três grupos temáticos: (1) diagnóstico clínico, laboratorial e por imagem; (2) situações especiais e (3) tratamento. Na primeira parte estão os dois primeiros temas e o tratamento na segunda.

Chikungunya fever has become an important public health problem in countries where epidemics occur because half of the cases progress to chronic, persistent and debilitating arthritis. Literature data on specific therapies at the various phases of arthropathy caused by chikungunya virus (CHIKV) infection are limited, lacking quality randomized trials assessing the efficacies of different therapies. There are a few studies on the treatment of musculoskeletal manifestations of chikungunya fever, but these studies have important methodological limitations. The data currently available preclude conclusions favorable or contrary to specific therapies, or an adequate comparison between the different drugs used. The objective of this study was to develop recommendations for the treatment of chikungunya fever in Brazil. A literature review was performed via evidence-based selection of articles in the databases Medline, SciELO, PubMed and Embase and conference proceedings abstracts, in addition to expert opinions to support decision-making in defining recommendations. The Delphi method was used to define the degrees of agreement in 2 face-to-face meetings and several online voting rounds. This study is part 2 of the Recommendations of the Brazilian Society of Rheumatology (Sociedade Brasileira de Reumatologia - SBR) for the Diagnosis and Treatment of chikungunya fever and specifically addresses treatment. Resumo A febre chikungunya tem se tornado um importante problema de saúde pública nos países onde ocorrem as epidemias, visto que metade dos casos evolui com artrite crônica, persistente e incapacitante. Os dados na literatura sobre terapêuticas específicas nas diversas fases da artropatia ocasionada pela infecção pelo vírus chikungunya (CHIKV) são limitados, não existem estudos randomizados de qualidade que avaliem a eficácia das diferentes terapias. Há algumas poucas publicações sobre o tratamento das manifestações musculoesqueléticas da febre chikungunya, porém com importantes limitações metodológicas. Os dados atualmente disponíveis não permitem conclusões favoráveis ou contrárias a terapêuticas específicas, bem como uma adequada avaliação quanto à superioridade entre as diferentes medicações empregadas. O objetivo deste trabalho foi elaborar recomendações para o tratamento da febre chikungunya no Brasil. Foi feita uma revisão da literatura com seleção de artigos baseados em evidência, nas bases de dados Medline, SciELO, PubMed e Embase e de resumos de anais de congressos, além da opinião dos especialistas para dar apoio às decisões tomadas para definir as recomendações. Para a definição do grau de concordância foi feita uma metodologia Delphi, em duas reuniões presenciais e várias rodadas de votação on line. Este artigo refere-se à parte 2 das Recomendações da Sociedade Brasileira de Reumatologia para Diagnóstico e Tratamento da Febre Chikungunya, que trata especificamente do tratamento.

In recent years, there has been a paradigm shift towards the development of disease activity indexes that correspond to the clinical measures and also the results reported by the patients, thus capturing the total burden of the disease.1 Disease Activity Index for Psoriatic Arthritis (DAPSA)2 is an index for measuring disease activity in psoriatic arthritis (PsA) that use C-reactive protein (CRP) as activity biomarker. Recently, van Mens et al 1 shown that the use of clinical DAPSA (cDAPSA) was similar to DAPSA using CRP. Our objective is evaluating whether CRP influences the achievement of different DAPSA disease states, and therefore we compared DAPSA with and without CRP. Trained rheumatology collected clinical data from 124 eligible patients, including swollen and tender joint count (SJC 66 and TJC 68 joints). DAPSA is calculated with the number of painful joints …

Objective. To determine active TGF-β1 (aTGF-β1) levels in serum, skin, and peripheral blood mononuclear cell (PBMC) culture supernatants and to understand their associations with clinical parameters in systemic sclerosis (SSc) patients.Methods. We evaluated serum samples from 56 SSc patients and 24 healthy controls (HC). In 20 SSc patients, we quantified spontaneous or anti-CD3/CD28 stimulated production of aTGF-β1 by PBMC. The aTGF-β1 levels were measured by ELISA. Skin biopsies were obtained from 13 SSc patients and six HC, and TGFB1 expression was analyzed by RT-PCR.Results. TGF-β1 serum levels were significantly higher in SSc patients than in HC (p< 0.0001). Patients with increased TGF-β1 serum levels were more likely to have diffuse subset (p= 0.02), digital ulcers (p= 0.02), lung fibrosis (p< 0.0001), positive antitopoisomerase I (p= 0.03), and higher modified Rodnan score (p= 0.046). Most of our culture supernatant samples had undetectable levels of TGF-β1. No significant difference in TGFB1 expression was observed in the SSc skin compared with HC skin.Conclusion. Raised active TGF-β1 serum levels and their association with clinical manifestations in scleroderma patients suggest that this cytokine could be a marker of fibrotic and vascular involvement in SSc.

Background Although a number of cytokines and chemokines have been investigated as possible mediators of fibrosis in Systemic Sclerosis (SSc), specific correlation between cytokines and organ involvement have not been found yet, and a cytokine profile characteristic of SSc is far to be identified. Objectives Establish a profile of anti and profibrotic molecules involved in skin fibrosis of SSc patients. Methods The mRNA expression was detected by real-time quantitative polymerase chain reaction (RT-qPCR) in skin9s biopsies from 14 patients: 7 patients with cutaneous diffuse SSc (dSSc) and 7 patients with cutaneous limited SSc (lSSc), and 5 sex and age-matched controls. All patients with SSc were biopsied at a lesional forearm site, and met the American College of Rheumatology (ACR) criteria for the classification of SSc. The transcriptome of samples extracted from skin biopsies of SSc and healthy controls was observed using quantitative real-time-polymerase chain reaction (qRT-PCR) of eleven molecules: TGF-b, PDGF, CTGF, CCL3, IL-6, IL-13, IL-7, IFNg, IL-17, IL-22, and RORc Results The CCL3, IL-13, IFN-g and IL-7 were more expressed in the SSc9s skin (respectively, p=0.0002, p=0.0243, p=0.0335, p=0.0082) when compared with healthy controls. We found positive correlation in expression levels between CCL3 and IL-7 (p=0.0050 r =0.7187), besides a negative correlation between IL-7 and TGF-b (p=0,0136 r = -0,6527). Furthermore, we obtained relation with some clinical manifestation and the relative genes expression. Conclusions We demonstrated that the relative mRNA expression of IL-7, IFN-g, CCL3 e IL-13 were increased on the microenvironment of the SS9s skin when compared with the healthy controls. Our study suggests interesting correlation between IL-7 and CCL3, so we propose large studies with SSc to establish the real role of these two molecules. Furthermore, we also ratified the potential probability antifibrotic role of IL-7 as well IFN-g. Acknowledgements We thank Dr. Emerson Andrade Lima for performing the skin biopsies Disclosure of Interest None declared

Background Experimental studies indicate that interleukin-35 (IL-35) is an important anti-inflammatory cytokine and can efficiently suppress T effector cell activity and reduce the progression of inflammatory and autoimmune diseases. However, its real role in the pathophysiology of human diseases is still unclear. Objectives To assess the serum IL-35 level and its association with clinical manifestations in patients with Systemic Sclerosis (SSc). Methods IL-35 serum levels were measured by ELISA from 56 patients with SSc and 53 healthy controls. Association of IL-35 serum levels with clinical parameters were sought. Results Serum IL-35 levels were significantly higher in SSc patients (5.08±0.76pg/ml) than in healthy individuals (1.89±0.69 pg/ml; P Conclusions IL-35 is elevated in the serum of patients with SSc and is associated with lung fibrosis. Our findings suggest that this cytokine can have a role in fibrotic diseases but further studies are needed to address the role of IL-35 in the pathogenesis of SSc. References Collison LW, Workman CJ, Kuo TT, Boyd K, Wang Y, Vignali KM, et al. The inhibitory cytokine IL-35 contributes to regulatory T-cell function. Nature 2007;450:566-9. Niedbala W, Wei XQ, Cai B, Hueber AJ, Leung BP, McInnes IB, et al. IL-35 is a novel cytokine with therapeutic effects against collagen-induced arthritis through the expansion of regulatory T cells and suppression of Th17 cells. Eur J Immunol;37:3021-9. Ouyang H, Shi YB, Liu ZC, Wang Z, Feng S, Kong SM, et al. Decreased interleukin 35 and CD4+EBI3+ T cells in patients with active systemic lupus erythematosus. Am J Med Sci 2014;348:156-61. Disclosure of Interest None declared