It is recommended to evaluate the presence of latent tuberculosis infection (LTBI) prior to the use of antitumor necrosis factor α. The aim of this study is to assess the presence of LTBI in patients with rheumatic diseases undergoing treatment with infliximab in an endemic area for tuberculosis (TB). LTBI was searched through the contact history, chest X-ray and tuberculin skin test with purified protein derivative (PPD) ≥5 mm. We studied 157 patients in the period from May 2005 to October 2008, 99 (63.1%) were women with average age of 49 years and 58 (36.9%) were men with average age of 41 years. The group comprising 90 patients (57.3%) with rheumatoid arthritis (RA), 54 (34.4%) with ankylosing spondylitis (AS) and 13 (8.3%) with psoriatic arthritis (PsA) had PPD reactor 13.4% (21/157), being prevented by isoniazid (INH) in these patients. There are dissimilar responsiveness to the PPD between the three pathologies, and the reactivity was lower in RA (RA × AS: χ(2) = 12; P = 0.0004; and RA × PsA: χ(2) with Yates' correction = 3.6; P = 0.05). No significant difference between the reactivity of the PPD and the use of immunosuppressive drugs (P = 0.81) is observed. The immunoprophylaxis with INH showed an efficacy of 95% (20/21); three (1.9%) patients developed active TB (spondylodiscitis, meningitis and lymphadenopathy) after the use of infliximab, reaffirming extrapulmonary involvement. These results suggest that PPD has a low sensitivity for detection of LTBI in RA and that the previous use of immunosuppressive drugs does not affect the response to PPD.

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Objective: To identify tuberculosis infection in rheumatic patients on infliximab by use of PPD testing prior to immunobiologic therapy. Methods: This study comprised 157 patients undergoing infliximab treatment and 734 other patients undergoing laboratory screening for tuberculosis infection originating from several services. The Mantoux technique was used for PPD testing, and an induration of at least 5 mm was considered reactive status. Results: In the infliximab group, 13% of the patients reacted to PPD, while, in the other group, 27% of the patients reacted to PPD (χ 2 = 13; P = 0.0003). These patients were divided into categories: adults with chronic diseases, PPD reactivity of 22%; and other controls, PPD reactivity of 31%. This shows the heterogeneous response of that population (χ 2 = 7; P < 0.009). In the infliximab group, subdivided according to pathologies [rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PA)], different reactivity rates were observed, the lowest value occurring among RA patients: (RA x AS: OR = 0.13; CI: 0.03-0.47; χ 2 = 12; P = 0.0004) and (RA x PA: OR = 0.16; CI: 0.02-1.04; χ 2 Yates corrected = 3.6; P = 0.05). The PPD reactivity in the RA subgroup (4%) was also lower as compared with that of the chronic patients group (22%) (OR = 0.16; CI: 0.05-0.49; χ 2 = 14; P = 0.0002), even when reclassified into four subgroups: rheumatology (OR = 0.19; CI: 0.04-0.72), kidney transplantation (OR = 0.16; CI: 0.05-0.51), infectology (OR = 0.21; CI: 0.05-0.75), and other conditions (OR = 0.13; CI: 0.04-0.44). Conclusion: The low prevalence of PPD reaction in this Brazilian population, mainly in chronic patients, with the worst performance among RA patients, shwoed that the test has limited value for diagnosis of tuberculosis infection in candidates to infliximab therapy.

Objetivo: Identificar a caracterização do uso do alendronato sódico por pacientes em tratamento para osteoporose na Atenção Primária à Saúde (APS) no município de Sobral, CE, e relacionar os possíveis fatores que poderiam influenciar a adesão ao tratamento medicamentoso. Métodos: Estudo observacional, transversal, descritivo e quantitativo. Foi realizado com o uso de um questionário, entre fevereiro e março de 2012, com 90 pacientes em tratamento para osteoporose com alendronato sódico, de ambos os sexos e maiores de 50 anos. Resultados: Noventa e nove porcento dos pacientes eram representados pelo o sexo feminino. Sobre a faixa etária, 67% correspondiam a mais de 60 anos. Houve predominância de fratura na coluna em 45% dos pacientes. Sessenta e dois porcento ingeriam o alendronato de forma inadequada e 43% relataram alguma reação adversa ao medicamento. Conclusão: O uso inadequado do alendronato de sódio pelos pacientes, assim como sua ausência nos Centros de Saúde da Família (CSF), são fatores que influenciam diretamente na não adesão ao tratamento da osteoporose. É importante que sejam desenvolvidas ações de educação em saúde sobre o uso adequado desse medicamento como forma de garantia de qualidade de vida.

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Objective: Chresta martii is broadly used by folk medicine due to its anti-inflammatory effects, but there is a lack of preclinical data on its pharmacological mechanisms. This study investigated the efficacy of Chresta martii ethanolic extract (CEE) in the zymosan-induced temporomandibular joint arthritis (TMJ) and evaluated the possible role of TNF-α, nitric oxide (NO), and heme oxygenase-1 (HO-1). Methods: Male Wistar rats (160-220 g) were pre-treated with CEE (100, 200 or 400 mg/kg; v.o) 1 h before zymosan injection (2 mg; i.art). Mechanical hypernociception (g) was assessed 4 h later. The trigeminal ganglion was collected for TNF-α quantification (ELISA), total cell count and myeloperoxidase activity (MPO) were assayed in the synovial lavage 6 h after arthritis induction. Additionally, animals were pre-treated with L-NAME (30 mg/kg; i.p.) or ZnPP-IX (3 mg/kg, s.c.) to assess the involvement of NO and HO-1, respectively. Results: CEE 400 mg/kg (v.o) increased (p < 0.05) hypernociception threshold, reduced the cell counts and MPO activity in the synovial lavage, as well as decreased TNF-α levels in the trigeminal ganglion. ZnPP-IX abolished the analgesic effect of CEE, but not L-NAME. Conclusion:The anti-inflammatory and antinociceptive effects of CEE depended on the HO-1 pathway integrity and TNF-α suppression.

Amyloidosis is a heterogeneous group of diseases characterized by extracellular deposits of a material composed of aggregates of amyloid -a poorly coupled protein -far from the site of synthesis, causing target organ dysfunction and clinical disease. Systemic amyloidosis A (AA), secondary to infections and chronic inflammation, especially rheumatoid arthritis (RA), is the most common form of amyloid deposition. Treatment of AA consists in the control or resolution of the baseline condition. The objective of the present study was to report a case of secondary renal amyloidosis in a patient with long-term refractory RA who presented sustained clinical improvement after the use of anti-TNFα (etanercept).

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