Several studies point to the increased risk of reactivation of latent tuberculosis infection (LTBI) in patients with chronic inflammatory arthritis (CIAs) after using tumour necrosis factor (TNF)α blockers. To study the incidence of active mycobacterial infections (aMI) in patients starting TNF α blockers, 262 patients were included in this study: 109 with rheumatoid arthritis (RA), 93 with ankylosing spondylitis (AS), 44 with juvenile idiopathic arthritis (JIA) and 16 with psoriatic arthritis (PsA). All patients had indication for anti-TNF α therapy. Epidemiologic and clinical data were evaluated and a simple X-ray and tuberculin skin test (TST) were performed. The control group included 215 healthy individuals. The follow-up was 48 months to identify cases of aMI. TST positivity was higher in patients with AS (37.6%) than in RA (12.8%), PsA (18.8%) and JIA (6.8%) (p < 0.001). In the control group, TST positivity was 32.7%. Nine (3.43%) patients were diagnosed with aMI. The overall incidence rate of aMI was 86.93/100,000 person-years [95% confidence interval (CI) 23.6-217.9] for patients and 35.79/100,000 person-years (95% CI 12.4-69.6) for control group (p < 0.001). All patients who developed aMI had no evidence of LTBI at the baseline evaluation. Patients with CIA starting TNF α blockers and no evidence of LTBI at baseline, particularly with nonreactive TST, may have higher risk of aMI.

O trabalho, derivado de pesquisa em andamento, tem como objeto de pesquisa mortes decorrentes da intervenção policial (MDIP) na cidade do Recife/PE. Considerando a produção sobre a temática, que aponta a não resolutividade dos homicídios, propõe-se discutir representações sociais das polícias, nesses casos, a partir de um estudo de caso. A hipótese, trilhando a revisão de literatura na temática, indica permanente estado de exceção, no qual as mortes produzidas pela atividade policial são acobertadas por um manto de legalidade conferido pelo Ministério Público e pelo Poder Judiciário. Metodologicamente, optou-se por realizar um estudo de caso e partiu-se do pressuposto que os discursos que permeiam o texto dos atos decisórios são uma violência de imposição de verdade e que variam em função das estruturas sociais em que se inserem os indivíduos, razão pela qual é indispensável uma chave analítica do racismo estrutural para perceber o oculto sobre os textos.

Introdução: abscesso do músculo psoas é uma complicação infecciosa infreqüente que se associa à imunodeficiência. Objetivo: relatar as manifestações clínicas, diagnóstico e evolução de uma paciente com síndrome de sobreposição de Lúpus Eritematoso Sistêmico e Artrite Reumatóide.

Background TNFα blockers are effective options for the treatment of different forms of chronic inflammatory arthritis (CIA). However, these drugs are associated with a greater frequency of adverse events, especially infectious and allergic events. Objectives To evaluate the incidence and the main risk factors associated with cutaneous adverse events (CAE) in patients with CIA following anti-TNF therapy. Methods A total of 257 patients with active CIA and under using TNFα blockers were analyzed – 158 with rheumatoid arthritis (RA), 87 with ankylosing spondylitis(AS) and 12 with psoriatic arthritis (PA) – in a prospective analysis from January 2005 to December 2009. Patients with active or chronic infection, including hepatitis B, hepatitis C or human immunodeficiency virus, and those with overlap of other autoimmune rheumatic diseases were excluded. Anthropometric, socioeconomic, demographic and clinical data were evaluated, including DAS28, BASDAI and PASI. Skin conditions were evaluated by two dermatologists and a biopsy was performed in cases of doubt. Infectious events were classified as viral, parasitic, fungal or bacterial, depending on the clinical condition or identification of the etiological agent. Associations between CAE and clinical, demographic and epidemiological variables were determined using the chi-square test and logistic regression analyses for the identification of risk factors. The level of significance was set at 5% (p<0.05). Results After 60 months of follow up, 71 CAE (73.85/1000 patients-year) were observed, especially related to allergic and immune-mediated phenomena (37.93/1000 patients-year), followed by infectious conditions (34.71/1000 patients-year), including bacterial (47.1%), parasitic (23.5%), fungal (20.6%) and viral (8.8%). Three CAE (4.22%) were classified as serious. The main risk factors significantly associated with CAE were advanced age (OR=1.09; 95%CI: 1.05-3.72), female gender (OR=2.8; 95%CI: 1.90-5.63), diagnosis of RA (OR=1.9; 95%CI: 1.11-4.62), disease activity [DAS28: OR=1.5; 95%CI: 1.2-4.68 or BASDAI: OR=1.1; 95%CI: 1.02-6.37], use of IFX (OR=1.6; 95%CI: 1.06-4.01), independently from time since diagnosis. These reactions generally had a good prognosis after withdrawal of medications and specific treatment. Conclusions Our results demonstrate that the skin is an important site affected by adverse reactions following TNFα blockers. References Smolen JS, Landewé R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Ann Rheum Dis 2010; 69: 964-975. van der Heijde D, Sieper J, Maksymowych WP, et al. 2010 Update of the international ASAS recommendations for the use of anti-TNF agents in patients with axial spondyloarthritis. Ann Rheum Dis 2011; 70: 905-911. Ritchlin CT, Kavanaugh A, Gladman DD, et al. Treatment recommendations for psoriatic arthritis. Ann Rheum Dis 2009; 68: 1387-1394. Disclosure of Interest None Declared