The SAPORI is a simple, useful, fast, practice, and valid tool for identifying women at higher risk for low bone density and osteoporotic fractures.

Correspondence of these patients, regarding the risk of death, especially in those with recent use of corticosteroids, reinforcing that protective measures need to keep on being recommended, and the rheumatologists should weigh the peculiarities of each disease and the immunosuppression to better manage them.

The objective of this study was to evaluate traditional risk factors for cardiovascular disease (CVD) and endothelin-1 (ET-1) levels in Takayasu arteritis (TA) patients. Twenty-two TA patients and 37 controls were evaluated. TA patients had a higher prevalence of hypertension (63.6% vs. 21.6%, p=0.001) and higher levels of triglycerides (129.5 mg/dL+/-70.8 vs. 88.4 mg/dL+/-60.8, p=0.017) than controls. Mean number of CVD risk factors was 1.64+/-1.22 in TA patients and 1.03+/-1.44 among controls, p=0.030. More TA patients presented at least one CVD risk factor when compared to controls (77.2% vs. 51.3%, p=0.048). ET-1 levels were higher in patients than in controls (1.49 pg/mL+/-0.45 vs. 1.27 pg/mL+/-0.32, p=0.034), however no significant difference was found between patients with active and inactive disease. In this study, TA patients presented a higher prevalence of hypertension, higher levels of triglycerides, and ET-1 than controls.

Objectives To evaluate the disease activity before and after COVID-19 and risk factors associated with outcomes, including hospitalization, intensive care unit (ICU) admission, mechanical ventilation (MV) and death in patients with spondylarthritis (SpA). Methods ReumaCoV Brazil is a multicenter prospective cohort of immune-mediated rheumatic diseases (IMRD) patients with COVID-19 (case group), compared to a control group of IMRD patients without COVID-19. SpA patients enrolled were grouped as axial SpA (axSpA), psoriatic arthritis (PsA) and enteropathic arthritis, according to usual classification criteria. Results 353 SpA patients were included, of whom 229 (64.9%) were axSpA, 118 (33.4%) PsA and 6 enteropathic arthritis (1.7%). No significant difference was observed in disease activity before the study inclusion comparing cases and controls, as well no worsening of disease activity after COVID-19. The risk factors associated with hospitalization were age over 60 years (OR = 3.71; 95% CI 1.62–8.47, p = 0.001); one or more comorbidities (OR = 2.28; 95% CI 1.02–5.08, p = 0.001) and leflunomide treatment (OR = 4.46; 95% CI 1.33–24.9, p = 0.008). Not having comorbidities (OR = 0.11; 95% CI 0.02–0.50, p = 0.001) played a protective role for hospitalization. In multivariate analysis, leflunomide treatment (OR = 8.69; CI = 95% 1.41–53.64; p = 0.023) was associated with hospitalization; teleconsultation (OR = 0.14; CI = 95% 0.03–0.71; p = 0.01) and no comorbidities (OR = 0.14; CI = 95% 0.02–0.76; p = 0.02) remained at final model as protective factor. Conclusions Our results showed no association between pre-COVID disease activity or that SARS-CoV-2 infection could trigger disease activity in patients with SpA. Teleconsultation and no comorbidities were associated with a lower hospitalization risk. Leflunomide remained significantly associated with higher risk of hospitalization after multiple adjustments.

Background Cardiovascular (CV) diseases are the most relevant causes of mortality in patients with autoimmune rheumatic diseases (AIRD), including rheumatoid arthritis (RA), ankylosing spondylitis (AS) and systemic lupus erythematosus (SLE). Supervised physical exercise (SPE) is an important non-pharmacological strategy for clinical management of these patients, particularly on aspects related to metabolic syndrome and other concomitant diseases. Objectives To evaluate the impact of a simple ergometric test (ET) in patients with AIRD, without cardiovascular symptoms, before starting a SPE. Methods A total of 264 ET from sedentary 133 RA, 84 AS and 47 SLE patients were analyzed. The patients underwent ET before starting a SPE program in order to be included in 3 randomized clinical trials. Patients with CV symptoms, previous CV events, uncontrolled hypertension, severe disease activity or taking high doses of glucocorticosteroids and older than 60 years were excluded. All outcomes occurring after cardiac evaluation were examined to evaluate the impact of each one on the final clinical decision. Results From 264 baseline ET, 34 (12.9%) were considered positive. These patients were not included in the controlled and randomized SPE and a cardiologic evaluation was recommended. The main peculiarities of these patients as well as the outcomes can be seen in Table 1. After cardiologic evaluation, the most of them were considered clinically relevant, since there were changes in diagnosis and therapeutic management, including invasive procedures (cardiac catheterization) and specific medications. If the ET had not been performed, these patients have been missed and would be at CV risk. Table 1. Main clinical peculiarities and outcomes of the patients with autoimmune rheumatic diseases after ergometric test RA patients (N=133)AS patients (N=84)SLE patients (N=47) Age (years)54.2±4.1 (18-60)41.8±9.7 (18-60)32.9±7.7 (18-45) Female gender (%)10022100 Time of disease (years)8.6±3.514.6±7.98.2±6.5 Positive ET (N; %)24; 68.6%6; 17.6%4; 11.4% Outcome (%)  Hypertension11 (45.8%)1 (16.7%)2 (50%)  IHD3 (12.5%)4 (66.6%)0  VA6 (25%)1 (16.7%)1 (25%)  PH001 (25%)  Fatigue/exhaustion4 (16.7%)00 IHD: ischemic heart disease; VA: ventricular arrhythmia; PH: pulmonary hypertension. Conclusions Positive ET is frequent in asymptomatic patients with AIRD, particularly in RA patients. In addition, these CV abnormalities had serious clinical implications, such as systemic and pulmonary hypertension, arrhythmia and ischemic heart disease. Our data suggest that asymptomatic and sedentary patients with RA, AS and SLE should be evaluated for CV diseases before starting moderate to vigorous exercise programs. References Garber CE, Blissmer B, Deschenes MR et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011; 43 (7): 1334-59. ...

Background Cardiovascular disease (CVD) is an important cause of morbidity and mortality in systemic lupus erythematosus (SLE) and disturbances in endothelial function (EF) are implicated in its pathogenesis (1,2). EF also depends on endothelial progenitor cells (EPCs) that enhance angiogenesis, promote vascular repair and have potential as a marker of CVD (3,4,5). SLE patients have endothelial dysfunction and fewer EPCs (6,7). Objectives To evaluate the effect of supervised physical exercise (SPE) on quality of life, exercise tolerance, body composition, endothelial function, EPCs number and on vascular endothelial growth factor (VEGF) level in SLE patients. Methods Prospective, controlled, nonrandomized study. Women with SLE were allocated according to availability to participate in exercise group (EG) or control group (CG). Intervention: SPE was performed for 1 hour, 3X/week, for 16 weeks. Patients were evaluated at baseline (T0) and after 16 weeks (T16): exercise tolerance by cardiopulmonary exercise test; quality of life by SF-36; body composition by DEXA; high-resolution ultrasound of brachial artery in resting conditions, after reactive hyperaemia (flow-mediated dilation-FMD) and after oral glyceryl trinitrate (GTMD) was performed to assess endothelial function; EPCs were evaluated by flow cytometry using anti-CD34 (FITC), anti-CD133 (PE) and anti-KDR (APC); and VEGF was assessed by ELISA (R&D Systems, Minneapolis, USA). Results 535 SLE patients were invited, 239 manifested interest, but 127 were excluded due to exclusion criteria. 55 patients dropped out due to personal reasons. Twenty four patients completed the evaluations (mean age 33.2±8.2 years and mean disease duration of 99±77.9 months). Thirteen patients were assigned in the EG and eleven in the CG. Both groups were comparable and homogeneous regarding demographic variables and cardiovascular traditional risk factors. After 16 weeks, we observed a significant increase in FMD (7.7±7.2% vs 16.9±8.8%, p=0.005) in EG without changes in the GC (4.1±4.4% vs 7.4±5.7%, p=0.62). In the EG, we also found a significant improvement in exercise tolerance (12±2.1min vs 13.5±2min, p=0.021), maximum speed (7.6±1km/h vs 8.3±1km/h, p=0.049), threshold speed (5.5±0.6km/h vs 5.9±0.6km/h, p=0.012), functional capacity (66.2±23.8 vs 82.1±11.6, p=0.035) and vitality (72.9±31.4 vs 78.8±19.7, p=0.007). EPCs were analyzed in 10 patients of the EG and in seven of the CG. We observed a significant increase in number of CD34/CD133/KDR positive cells at T16 in the EG (0.38±0.37 vs. 1.57±1.38, p=0.005), with no difference in the CG (0.62±0.83 vs. 0.82±0.58, p=0.176). There was no difference on body composition and VEGF levels in both groups comparing T0 and T16. Conclusions Despite the small sample, this is the first study demonstrating that SPE can improve EF and EPCs number in SLE patients. The higher number of EPCs may be one of the mechanisms associated with EF improvement after an exercise program. Physical exercise can be a useful strategy to prevent CVD morbidity and ...

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