Background Patients’ needs and perspectives are important determinants of treatment success in rheumatoid arthritis (RA). Assessing patients’ perspectives can help identify unmet needs and enhance the understanding of treatment benefits. Objective The SENSE study assessed the impact of inadequate response to disease-modifying antirheumatic drugs (DMARDs) on treatment satisfaction, disease outcomes, and patient perspectives related to RA disease management. Methods SENSE was a noninterventional, cross-sectional study conducted in 18 countries across Europe, Asia, and South America. Adult patients with poorly controlled RA of moderate/high disease activity were eligible. Patient satisfaction was assessed by the Treatment Satisfaction Questionnaire for Medication (TSQM v1.4). Treatment adherence, healthcare resource utilization (HRU), quality of life (QoL), work ability, digital health literacy (DHL), patient preference information, and treatment strategy were also assessed. Results A total of 1624 patients were included in the study: most were female (84.2%) and middle-aged, and mean disease duration was 10.5 years. Mean TSQM global satisfaction subscore was 60.9, with only 13.5% of patients reporting good treatment satisfaction (TSQM global ≥80). The strongest predictor of good treatment satisfaction was treatment with advanced therapies. Most patients (87.4%) reported good treatment adherence. In general, patients had impaired QoL and work ability, high HRU, and 67.4% had poor DHL. Leading treatment expectations were “general improvement of arthritis” and “less joint pain”. Most patients preferred oral RA medications (60.7%) and rapid (≤1 week) onset of action (71.1%). “Increased risk for malignancies” and “increased risk for cardiovascular disease” were the least acceptable side effects. Despite suboptimal control, advanced therapies were only used in a minority of patients, and DMARD switches were planned for only half of the patients. Conclusion Suboptimal disease control negatively impacts treatment satisfaction, work ability, QoL, and HRU. Data collected on patient perspectives may inform shared decision-making and optimize treat-to-target strategies for improving patient outcomes in RA.

Rheumatoid arthritis (RA) is a chronic and autoimmune systemic inflammatory disease that can cause irreversible joint deformities, with increased morbidity and mortality and a significant impact on the quality of life of the affected individual. The main objective of RA treatment is to achieve sustained clinical remission or low disease activity. However, up to 40% of patients do not respond to available treatments, including bDMARDs. New therapeutic targets for RA are emerging, such as Janus kinases (JAKs). These are essential for intracellular signaling (via JAK-STAT) in response to many cytokines involved in RA immunopathogenesis. JAK inhibitors (JAKi) have established themselves as a highly effective treatment, gaining increasing space in the therapeutic arsenal for the treatment of RA. The current recommendations aim to present a review of the main aspects related to the efficacy and safety of JAKis in RA patients, and to update the recommendations and treatment algorithm proposed by the Brazilian Society of Rheumatology in 2017.

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In this paper a spectral analysis of the aa geomagnetic index (aa) and of the sunspot number (SSN) time series during the period 1868-1998 is made. The spectral method used was the multiple taper method. The main periods found were related to the 11 year solar cycle and its harmonics. The aa spectrum shows in addition a period of 4.4 years, which is caused by the dual-peak distribution of the aa time series. The cross-correlation for all the periods indicates that aa lags SSN by 1 year, however the correlation is decreasing and the lag is increasing with time. Using averages of 23 years, cross-correlations calculations show that the correlation coefficient decreases from 0.76 to 0.35 and the lag from 0 (1868-1890) to -3 .

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.

BACKGROUNDRheumatoid arthritis (RA) is a chronic inflammatory disease that can cause impaired body composition, increased cardiovascular risk, reduced functionality and vitality. Fatigue is highly prevalent in RA, even though the relationship between fatigue and body composition and the impact on quality of life has not yet been fully elucidated. The objective was to establish the relationship between fatigue and body composition, quality of life, functionality, and disease activity in RA patients. METHODSA cross-sectional study in 100 adult patients with confirmed RA. Disease activity was assessed by clinical disease activity index (CDAI), fatigue by the vitality component of the short-form 36 (SF36) questionnaire, and functionality by healthy assessment questionnaire (HAQ). Body composition by double X-ray absorptiometry (DXA) was performed to provide values of fat mass percentage and the appendicular lean mass index adjusted for fat mass (adj ALM Z-score). Fatigue was measured as the vitality component of SF36. RESULTSThe vitality component of SF36 showed a mean (SD) value of 52.9 (25.73). Fatigue was positively associated to emotional component SF36 (p < 0.001), mental health component SF36 (p < 0.001) and negatively associated to HAQ (p < 0.001) and CDAI (p < 0.001). At the multivariate regression analysis HAQ and mental health SF36 were responsible for 71.85% of fatigue result. Body composition analysis did not show association with fatigue, neither for fat mass percentage (p = 0.927) nor for adj ALM Z-score (p = 0.437). CONCLUSIONFatigue is associated to impaired quality of life, and inversely associated to disease activity and functionality in RA patients. Body composition was not associated to fatigue in our sample.

Background Some studies have suggested the HLA-B27 gene may protect against some infections, as well as it could play a benefit role on the viral clearance, including hepatitis C and HIV. However, there is lack of SARS-CoV-2 pandemic data in spondyloarthritis (SpA) patients. Aim To evaluate the impact of HLA-B27 gene positivity on the susceptibility and severity of COVID-19 and disease activity in axial SpA patients. Methods The ReumaCoV-Brasil is a multicenter, observational, prospective cohort designed to monitor immune-mediated rheumatic diseases patients during SARS-CoV-2 pandemic in Brazil. Axial SpA patients, according to the ASAS classification criteria (2009), with (cases) and without (control group) COVID-19 diagnosis, were paired to sex and age. Other immunodeficiency diseases, past organ or bone marrow transplantation, neoplasms and current chemotherapy were excluded. Demographic data, managing of COVID-19 (diagnosis, treatment, and outcomes, including hospitalization, mechanic ventilation and death), comorbidities, clinical details (disease activity and concomitant medication) were collected using the Research Electronic Data Capture (REDCap) database. Data are presented as descriptive analysis and multiple regression models, using SPSS program, version 20. P level was set as 5%. Results From May 24th, 2020 to Jan 24th, 2021, a total of 269 axial SpA patients were included, of whom 165 (61.3%) with COVID-19 and 104 (38.7%) without COVID-19. Most of them were men (N = 153; 56.9%) with mean age of 46.3 ± 13.8 years and long-term disease (13.1 ± 9.9 years). There were no significant statistically differences concerning social distancing, smoking, BMI, waist circumference and comorbidities. Regarding b-DMARDs, 134 (75.3%) were on TNF inhibitors and 17 (9.6%) on IL-17 antagonists. Comparing those patients with and without COVID-19, the HLA-B27 positivity was not different between groups (n = 45, 73.8% vs. n = 38, 73.1%, respectively; p = 0.93). In addition, disease activity was similar before and after the infection. On the other hand, the control group had significantly higher disease activity score, according to ASDAS-CRP (2.8 ± 1.8 vs. 1.8 ± 1.2, p = 0.03). Interestingly, no new episodes of arthritis, enthesitis or extra-musculoskeletal manifestations were reported after the COVID-19. The mean time from the first symptoms to hospitalization was 7.2 ± 3.6 days, with length of hospitalization quite similar between patients who died and those discharged (12.6 ± 7 and 13.9 ± 11.7, respectively). The global death estimation for COVID-19 was 1.9 (95%CI 0.6–4.3), regardless HLA-B27 status. No significant difference was found regarding concomitant medications, including conventional or biologic DMARDs between the groups. Conclusions No significant difference of COVID-19 frequency rate was observed in patients with axial SpA regarding the HLA-B27 positivity, suggesting a lack of protective effect with SARS-CoV-2 infection. In addition, the disease activity was similar before and after the infection. Trial registration: This study was approved by the Brazilian Committee of Ethics in Human Research (CONEP), CAAE 30186820.2.1001.8807, and was registered at the Brazilian Registry of Clinical Trials – REBEC, RBR-33YTQC. All patients read and signed the informed consent form before inclusion.

BACKGROUNDCalcineurin inhibitor-induced pain syndrome (CIPS) is a rare reaction, probably secondary to bone vasoconstriction induced by these medications. Its most common presentation is a form of symmetrical arthralgia of the knees, ankles and feet. Pain can be severe and disabling, impairing the quality of life of these patients. Diagnosis is made based on the clinical history related to the use of medication and the aid of imaging tests such as magnetic resonance (MRI) and bone scintigraphy. CASE REPORTMale patient, 41 years old, previously with systemic arterial hypertension, hypothyroidism and chronic kidney disease secondary to IgA nephropathy, having undergone kidney transplantation in August 2019, using tacrolimus (TAC), sirolimus and prednisone 5 mg/day, presenting arthralgia in both knees started in January 2021, with mechanical rhythm, without associated morning stiffness. He sought an orthopedist in his city after 15 days of onset of symptoms, being referred to physiotherapy, in which he performed 10 sessions. Initially, the symptoms improved, but it recurred with pain, with the same characteristics. He came to Santa Casa de Belo Horizonte (SCBH) 3 months after the onset of the condition due to the persistence of the symptom. He denied morning stiffness, arthritis, low back pain, xerostomia, xerophthalmia, alopecia, oral ulcers, dysuria, hematuria, dyspnea, and cough. He had an isolated febrile episode (38 °C) on the day of admission. He reported loss of 7 kg since the onset of joint pain. CAT levels were at the lower limit of normality. Magnetic resonance imaging was performed on the left knee, which showed diffuse signal changes in the distal femoral metaepiphyseal bone marrow and proximal tibiofibular bone marrow associated with distal femoral periosteal reaction. This finding was attributed to CIPS. The patient was kept under observation, with no change in the therapeutic regimen. He returned to the SCBH Nephrology outpatient clinic after one month whose examination showed a reduced serum CAT level, without arthralgia. CONCLUSIONAlthough rare and little recognized, CIPS is a complication that can be found in patients undergoing solid organ or marrow transplantation and using tacrolimus or cyclosporine. Pain can be severe and limiting and its early recognition can help improve the quality of life of these patients.