. Roberto Ezequiel Heymann and Eduardo dos Santos Paiva received honorariums from Lilly, Janssen-Cilag, Boehringer, Apsen, and Pfizer for speeches and consulting services; Milton Helfenstein Junior received honorariums from Pfizer and Merck Sharp for speeches and consulting services; Daniel Feldman Pollak received honorariums from Lilly, Pfizer, and Merck Sharp; José Eduardo Martinez received honorariums from Sanofi Aventis, for speeches, and Pfizzer, for speeches and consulting services; José Roberto Provenza received honorariums from Roche, Bristol, Ache, and Pfizer to participate in clinical studies with new drugs at PUC-Campinas; Marcelo Cruz Rezende received honorariums from LillyBoehringer, to participate in symposiums, and from Pfizer, for speeches and to participate in sympostiums; valério valim Cristo received honorariums from Roche for presentations, conferences, or speeches, besides financing for studies, teaching organization, or to attend symposiums sponsored by Lilly, Genzyme, and Schering-Plough.

Background: To determine the burden of Rheumatoid Arthritis (RA) on patients' work productivity and health related quality of life (HRQoL), and examine the influence of several exposure variables; to analyze the progression of RA over 1 year and its impact on work productivity and HRQoL. Methods: International multicenter prospective survey including patients in 18 centers in Argentina, Brazil, Colombia and Mexico with diagnosis of RA and aged between 21-55 years. The following standard questionnaires were completed at baseline and throughout a 1-year follow-up: WPAI:RA, WALS, WLQ-25, EQ-5D-3 L and SF-36. Clinical and demographic variables were also collected through interview. Results: The study enrolled 290 patients on baseline visit. Overall mean scores at baseline visit were: WPAI:RA (presenteeism) = 29.5% (SD = 28.8%); WPAI:RA (absenteeism) = 9.0% (SD = 23.2%); WPAI:RA (absenteeism and presenteeism) = 8.6% (SD = 22.6%); WALS = 9.0 (SD = 6.1); WLQ-25 = 7.0% (SD = 5.1%); SF-36 Physical Scale = 39.1 (SD = 10.3) and Mental Scale = 45.4 (SD = 11.3); EQ-5D-3 L VAS = 69.8 (SD = 20.4) and EQ-5D-3 L index = 0.67 (SD = 0.23). Higher educational levels were associated with better results in WLQ-25, while previous orthopedic surgeries reduced absenteeism results of WPAI:RA and work limitations in WLQ-25. Higher disease duration was associated with decreased HRQoL. Intensification of disease activity was associated with decreased work productivity and HRQoL, except in WLQ-25. In the longitudinal analysis, worsening in disease activity was associated with a decrease in both work productivity and HRQoL. Conclusions: RA patients are dealing with workplace disabilities and limitations and loss in HRQoL, and multiple factors seems to be associated with this. Worsening of disease activity further decreased work productivity and HRQoL, stressing the importance of disease tight control.

The aim of this study was to evaluate clinical and urodynamic observations on women with fibromyalgia (FM) and lower urinary tract symptoms (LUTS). Fifty-one patients with FM and LUTS and 50 patients with LUTS without FM answered questions about urinary symptoms and also two questionnaires about quality of life measures: "Medical Outcomes Study 36-Item Short-Form Health Survey" and "King's Health Questionnaire". The urodynamic parameters evaluated were the following: maximum cystometric capacity, urine loss due to cough, Valsalva leak point pressure, and detrusor overactivity (DO). The groups were homogeneous concerning age, parity, body mass index, and genital prolapse. Symptoms such as increase of urinary frequency (p=0.007) and urge urinary incontinence (p=0.004) were statistically more common in the FM group. DO was the statistically most common urodynamic observation in patients with FM (p=0.02). Regarding the questionnaires about quality of life, the patients with fibromyalgia and LUTS had the worst results in all fields. In conclusion, patients with FM and LUTS have detrusor overactivity more often as well as an increase of urinary frequency, contributing to the quality of life worsening.

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The primary aim of this study was to assess the quality of life (Qol) in men with fibromyalgia (FM) as compared to the Qol of depressive patients, using the SF-36 questionnaire. The secondary objectives were as follows: to describe demographic and clinical characteristics of male patients with FM; to evaluate basal levels of dehydroepiandrosterone sulfate (DHEAS) and total testosterone in both groups; and to investigate the relationship among pain, tender points, anxiety, and depression in these patients. Fifty men with FM and 20 depressed males, matched by age and body mass index entered the study. All participants answered the SF-36, the Beck Depression Inventory and the State-Trait Anxiety Inventory questionnaire. Radioimmunoassay was used to determine serum concentration of DHEAS and total testosterone. Patients and controls had similar demographic characteristics. The scores were significantly lower in all domains of the SF-36 in patients with FM as compared with the depressive controls. No significant differences were observed among patient and control in the mean concentration of either DHEAS or total testosterone. Male patients with FM experience worse Qol than depressive men. Depression was influential on mental health, whereas FM impacted on both physical and mental health.

To evaluate the effects of aerobic training and stretching on serum levels of serotonin (5HT) and its main metabolite 5-hydroxindolacetic acid (5HIAA). Twenty-two women with FM were randomized into one of two exercise modalities (aerobic walking exercise or stretching exercise) to be accomplished three times a week for 20 weeks. The serum levels of 5HT and 5HIAA were evaluated before and after the exercise program by high performance liquid chromatography (HPLC) with colorimetric detection. Within group analysis (pre-post) showed that serum levels of both 5HT and 5HIAA changed significantly in the aerobic group during the 20-week course of therapy (5HT: P = 0,03; 5HIAA: P = 0,003). In the stretching group, however, no statistically significant change was observed (5HT: P=0,491; 5HIAA: P=0,549). Between group statistical comparisons of laboratory measures disclosed that aerobic training was superior to stretching in that it significantly increased the levels of 5HIAA (F test = 6.61; P = 0.01), but the average difference between groups on the levels of 5HT did not meet significance criteria (F test = 3.42; P = 0.08). Aerobic training increases the 5HIAA and 5HT levels and it could explain why aerobic exercise can improve symptoms in fibromyalgia syndrome patient more than stretching exercise.

The treatment of autoimmune rheumatic diseases has gradually improved over the last half century, which has been expanded with the contribution of biological therapies or immunobiopharmaceuticals. However, we must be alert to the possibilities of undesirable effects from the use of this class of medications. The Brazilian Society of Rheumatology (Sociedade Brasileira de Reumatologia/SBR) produced a document based on a comprehensive literature review on the safety aspects of this class of drugs, specifically with regard to the treatment of rheumatoid arthritis (RA) and spondyloarthritides. The themes selected by the participating experts, on which considerations have been established as the safe use of biological drugs, were: occurrence of infections (bacterial, viral, tuberculosis), infusion reactions, hematological, neurological, gastrointestinal and cardiovascular reactions, neoplastic events (solid tumors and hematologic neoplasms), immunogenicity, other occurrences and vaccine response. For didactic reasons, we opted by elaborating a summary of safety assessment in accordance with the previous themes, by drug class/mechanism of action (tumor necrosis factor antagonists, T-cell co-stimulation blockers, B-cell depletors and interleukin-6 receptor blockers). Separately, general considerations on safety in the use of biologicals in pregnancy and lactation were proposed. This review seeks to provide a broad and balanced update of that clinical and experimental experience pooled over the last two decades of use of immunobiological drugs for RA and spondyloarthritides treatment.

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