Health literacy, a more complex concept than knowledge, is a required capacity to obtain, understand, integrate and act on health information [1], in order to enhance individual and community health, which is defined by different levels, according to the autonomy and personal capacitation in decision making [2]. Medium levels of Health literacy in an adolescent population were found in a study conducted in 2013/2014, being higher in sexual and reproductive health and lower in substance use. It was also noticed that the higher levels of health literacy were in the area adolescents refer to have receipt more health information. The health literacy competence with higher scores was communication skills, and the lower scores were in the capacity to analyze factors that influence health. Higher levels were also found in younger teenagers, but in a higher school level, confirming the importance of health education in these age and development stage. Adolescents seek more information in health professionals and parents, being friends more valued as a source information in older adolescents, which enhance the importance of peer education mainly in older adolescents [3]. As a set of competences based on knowledge, health literacy should be developed through education interventions, encompassing the cultural and social context of individuals, since the society, culture and education system where the individual is inserted can define the way the development and enforcement of the health literacy competences [4]. The valued sources of information should be taken into account, as well as needs of information in some topics referred by adolescents in an efficient health education. Schizophrenia is a serious and chronic mental illness which has a profound effect on the health and well-being related with the well-known nature of psychotic symptoms. The exercise has the potential to improve the life of people with schizophrenia improving physical health and alleviating psychiatric symptoms. However, most people with schizophrenia remains sedentary and lack of access to exercise programs are barriers to achieve health benefits. The aim of this study is to evaluate the effect of exercise on I) the type of intervention in mental health, II) in salivary levels of alpha-amylase and cortisol and serum levels of S100B and BDNF, and on III) the quality of life and selfperception of the physical domain of people with schizophrenia. The sample consisted of 31 females in long-term institutions in the Casa de Saúde Rainha Santa Isabel, with age between 25 and 63, and with diagnosis of schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Physical fitness was assessed by the six-minute walk distance test (6MWD). Biological variables were determined by ELISA (Enzyme-Linked Immunosorbent Assay). Psychological variables were assessed using SF-36, PSPP-SCV, RSES and SWLS tests. Walking exercise has a positive impact on physical fitness (6MWD -p = 0.001) and physical components of the psychological test...

Comedication with csDMARDs does not prolong TNFi retention in patients with SpA in clinical practice, suggesting that there is no benefit conferred by the concomitant use of these drugs.

BackgroundPatients with rheumatic inflammatory conditions have an increased risk of premature death due to cardiovascular causes. It can be explained by the unfavourable interaction between the inflammatory process and the traditional cardiovascular risk factors. In obesity, especially if visceral, and in rheumatic diseases, there is production of pro-inflammatory cytokines, which contributes to an increase in cardiovascular risk. The influence of body mass index (BMI) on the evolution, activity and quality of life in rheumatoid arthritis (RA) and in psoriatic arthritis (PsA) has been proven. However, studies evaluating the influence of the abdominal circumference (AC) and metabolic syndrome (MS) are meagre.ObjectivesTo assess the influence of BMI, AC and MS, on disease activity and quality of life in RA and PA, using parameters of inflammatory activity (sedimentation rate (SR) and C-reactive protein (CRP), Activity Score (DAS28), Visual Analogue Pain Scale (VAS) and Health Assessment Questionnaire (HAQ) and to compare patients with RA and PA.MethodsA cross-sectional study, including 150 patients with RA, diagnosed according to the ACR/EULAR criteria and 75 patients with PsA (CASPAR criteria). Assessment of weight, height, AC, SR and CRP of all patients, clinical and demographic data collection. The presence of MS was assessed according to WHO definition. Participants completed HAQ and disease activity was measured by DAS28. SPSS was used for the statistical analysis, significance level was 2-sided p<0.050.ResultsAge, duration of illness, schooling and professional class were similar in RA and PsA. In RA there was a predominance of females (78.7%), while in PsA a predominance of males (53.3%). There were no differences between the quality of life (by HAQ), or in the disease activity (by DAS28 or by inflammatory parameters). PsA patients had significantly higher BMI and AC. The number of comorbidities was higher in cases of PsA. Dyslipidaemia and hyperuricemia were significantly more frequent in this group of patients. Independently the underlying pathology (RA or PsA), the number of comorbidities correlated positively with DAS28, with HAQ, CRP and SR.In RA group, there was a positive correlation of both BMI and AC with HAQ, also MS associated the highest HAQ values. Overweight/obesity (BMI≥25kg/m2) were associated with at least one painful joint. Still, the risk of having at least one swollen joint was 3.4 times higher in patients with increased AC (95% CI: 1.08-10.39). There was an association between the BMI and AC and the CRP value. Patients with BMI≥25 kg/m2 and with increased AC had DAS28 values significantly higher. MS was associated with significantly higher SR.In PsA group Patients with MS had higher CRP values, more joint pain and higher disease activity according to DAS28. Patients with BMI≥25kg/m2 also had more painful joints and higher CRP values. None of the patients with normal BMI had swollen joints, however 20.4% of overweight patients had at least one swollen joint. There was no association betwee...

Aim: Idiopathic inflammatory myopathies (IIM) comprise a group of rare and heterogeneous diseases difficult to diagnose and follow up. Precise measures for assessing disease activity are not available at the moment. Our objective was to evaluate the usefulness of ultrasonography (US) as a monitoring tool in IIM. Method:The study evaluated IIM patients diagnosed and followed up from 2005 to 2015 in our department. Fifteen patients with a mean age of 52.2 AE 22.09 years and mean disease duration of 4.6 AE 3.20 years were included. Physical examination including muscle strength tests, laboratorial analysis and a selective muscle US assessment were performed for each patient at a scheduled visit.Results: Nine of the 15 patients were in clinical remission and US assessment revealed a preserved muscle pattern. Symmetrical proximal muscle atrophy was found on US in one patient with longstanding polymyositis (PM) with proximal weakness. Inflammation and focal or generalized muscle edema were present on US in the remaining five patients with muscular weakness suggesting active disease. One of these patients in acute flare presented with atrophy changes in addition to edema. Early untreated myositis presented in one patient with moderate power Doppler (PD) signal. Conclusion:As far as muscle US assessment is concerned, a single specific pattern was not observed in our study. A mixture of muscle edema and atrophy was detected depending on disease activity and duration. US findings seem to correlate well with disease activity, suggested by clinical data, and may be a useful tool to complement patient evaluation.

Using a 12 joint US assessment, a high proportion of patients with DAS28 < 2.6 were found to have inflammatory US activity, and a significant proportion of patients had evidence of tenosynovitis of the tibialis posterior, which may be difficult to clinically detect. A regular and standardized US assessment of RA patients is therefore warranted to complement clinical evaluation and better define disease activity.

Lymphoid malignancies are a group of highly heterogeneous diseases frequently associated with constitutive activation of the nuclear factor kappa B (NF-κB) signaling pathway. Parthenolide is a natural compound used to treat migraines and arthritis and found to act as a potent NF-κB signaling inhibitor. This study evaluated in vitro parthenolide efficacy in lymphoid neoplasms. We assessed parthenolide metabolic activity in NCI-H929 (MM), Farage (GCB-DLBCL), Raji (BL), 697 and KOPN-8 (B-ALL), and CEM and MOLT-4 (T-ALL), by resazurin assay. Cell death, cell cycle, mitochondrial membrane potential (ΔΨmit), reactive oxygen species (ROS) and reduced glutathione (GSH) levels, activated caspase-3, FAS-ligand, and phosphorylated NF-κB p65 were evaluated using flow cytometry. CMYC, TP53, GPX1, and TXRND1 expression levels were assessed using qPCR. Our results showed that parthenolide promoted a metabolic activity decrease in all cell lines in a time-, dose-, and cell-line-dependent manner. The mechanism induced by parthenolide was demonstrated to be cell line dependent. Nonetheless, parthenolide promoted cell death by apoptosis with significant ROS increase (peroxides and superoxide anion) and GSH decrease combined with a ΔΨmit reduction across all studied cell lines. Despite the need to further understand parthenolide mechanisms, parthenolide should be considered as a possible new therapeutic approach for B- and T-lymphoid malignancies.

BackgroundPrimary Sjögren’s syndrome (pSS) is a multisystem immune-mediated disease characterized by hypofunction of salivary and lacrimal glands and possible multi-organ systemic manifestations. Over the past years, three sets of diagnostic criteria have been proposed, but none included salivary gland ultrasound (SGUS). However, SGUS has been recently applied for diagnosis and there are some reports regarding the correlation of SGUS findings with immunological and serological features in pSS patients (1, 2).ObjectivesTo investigate the association of SGUS fndings with clinical and analytical features of pSS patients.MethodsA total of 54 patients diagnosed with pSS, fulfilling both the 2016 ACR/EULAR and 2002 AECG criteria for the disease, followed-up at our Rheumatology department, underwent SGUS evaluation. The parenchymal homogeneity of bilateral parotid and submandibular glands was graded using a score of 0 (normal) to 4 (gross inhomogeneity). Patients were classified into two groups according to the highest US score obtained. The grades 1 and 2 were considered to be normal and grades 3 and 4 to represent pathological SGUS findings. Demographics (age, sex and disease duration), European League Against Rheumatism Sjögren’s Syndrome Disease Activity Index (ESSDAI) and laboratorial data (erythrocyte sedimentation rate, autoantibodies, rheumatoid factor, hypergammaglobulinemia, β2-microglobulin and complement levels) were collected and compared between the two SGUS groups. The association between SGUS and these data was explored by multivariable analysis. Statistical significance was defined as p <0.05.ResultsThe mean age of patients was 57.5±13.3 years and median disease duration was 5.0 [IQR (2.75-11.25)]. The majority of the study population were women (96%) and 35% (19/54) had pathological SGUS findings.Differences between the group with pathological SGUS versus the group with normal SGUS are depicted in table 1.Multivariate logistic regression revealed that anti-SSB ([OR] = 6.6, 95% [CI] 1.7 to 25.8, p = 0.006) was independently associated with the presence of pathological features in SGUS.Table 1 Comparison of demographics, clinical and serologic features of pSS according to SGUS. Pathological SGUS (n=19) Normal SGUS (n=35) P value Mean age, years 54.3±12.659.2±13.50.497 Mean disease duration, years 6.6±6.17.7±5.20.976 ESSDAI (IQR) 2.2 (0-5)0.9 (0-1) 0.044 Mean Sedimentation rate, mm 36.3±22.122.7±15.80.160 Antinuclear antibody, n (%) 19 (100)32 (91.4)0.544 Anti-SSA, n (%) 18 (94.7)27 (77.1)0.137 Anti-SSB, n (%) 14 (73.7)9 (25.7) 0.001 Rheumatoid factor, n (%) 14 (73.7)14 (40.0) 0.018 Hypergammaglobulinemia, n (%) 12 (63.2)14 (40)0.104 Mean β2-microglobulin, mg/L 2.9±0.92.2±0.70.378 Mean Complement 3, mg/dL 115.1±28.9120.7±24.50.938 Mean Complement 4, mg/dL 21.6±6.021.9±8.10.165 Hydroxychloroquine treatment, n (%) 15 (78.9)21 (60.0)0.229ConclusionIn our study, pathological US findings were associated with higher disease activity and positivity for rheumatoid factor and anti-SSB. Additionally, anti-SSB ...

Background:Although spondyloarthritis (SpA) is primarily a musculoskeletal condition, ocular involvement is an important clinical feature and contributes to the burden of disease. Acute anterior uveitis (AAU) is classically described as the most frequent extra-articular manifestation of SpA and in some cases the first clinical presentation. The prevalence of AAU varies according to the subtype of SpA. In a systematic literature review, the mean prevalence of AAU was 32.7% and a positive association between HLA-B27 positivity, axial SpA, male sex and uveitis has been reported (1). More recently, some cross-sectional studies have described lower odds of spondyloarthritis-related uveitis (SpA-U) in smokers than in patients who are ex smokers or never smokers (2). Predictors of SpA-U are poorly defined in literature and the influence of smoking status remains controversial.Objectives:To analyse the factors associated with uveitis in SpA patients in a Tertiary Rheumatology Center.Methods:An observational cross-sectional study was performed including patients fulfilling the ASAS criteria for axial SpA with a follow-up visit between January and June 2019. Clinical patients’ charts were reviewed and the following variables were considered: age, gender, history of uveitis (confirmed by ophthalmologist observation), number of AAU episodes, smoking status (never smoker or ever smoker), HLA-B27, disease duration, disease involvement (exclusively axial or axial and peripheral), history of enthesitis and syndesmophytes. History of AAU and associated variables were determined in this subset of patients.Statistical analysis was performed with logistic regression model. P value <.05 was defined as statistically significant.Results:The study included 164 patients (62.3% men) with median age of 44.0 years (IQR 37 to 54) and a median disease duration of 14.6 years (IQR 9.28 to 20.32). SpA diagnosis was ankylosing spondylitis in 70.7% cases and the remaining were non-radiographic axial SpA. HLA-B27 was positive in 84.8%, 31.1% of patients were ever smokers and 21% had both axial and peripheral joint involvement. Twenty four percent of patients had at least one AAU episode. Recurrence of uveitis occurred in 70% of patients. Ever smoking (OR=2.256; 95%CI [1.077-4.276]; p<.05) and syndesmophytes (OR=2.125; 95%CI [1.009-4.475]; p<.05) showed a statistically significant association with uveitis in univariated logistic regression. Althougth not statistically significant, a trend to association was found between smoking and recurrence of AAU (OR=2.235; 95%ICI [.973-5.135], p=.058). In multivariated logistic regression only ever smoking was independently associated with uveitis (OR=2.542; 95%CI [1.007-6.420]; p<.05). We did not find association between presence of uveitis and gender, age, disease duration, disease involvement, HLA-B27 positivity and enthesitis.Conclusion:Contrary to few cross-sectional studies showing a possible protective effect of smoking in SpA-U, and in line with new data from Zhaoet al(3), we report a statistically significant independent association between history of smoking and uveitis. Nevertheless, we emphasize the need of more studies to confirm these findings.References:[1] Zeboulon N, et al. Prevalence and characteristics of uveitis in the spondyloarthropathies: a systematic literature review. Annals of Rheumatic Diseases 2008;67:955.[2] Zhao S, et al. Associations between smoking and extra-axial manifestations and disease severity in axial spondyloarthritis: results from the BSR Biologics Register for Ankylosing Spondylitis (BSRBR-AS). Rheumatology 2018;69.[3] Zhao S, et al. Smoking does not protect patients with axial spondyloarthritis from attacks of uveitis. Annals of Rheumatic Diseases 2019;78(9).Disclosure of Interests:None declared