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Reumatologia

#Scientists discover new blood vessels in bone

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Researchers at University Duisburg-Essen, Germany have discovered new blood vessels in the long bones of mice, as well as similar new vessels in human long bones.

Blood vessels in bone - illustration by sciencepicssciencepics | Shutterstock

The vessels, which the scientists have called “trans-cortical vessels” (TCVs), were found to have originate in the bone marrow and traverse cortical bone perpendicularly along the shaft and connect to the periosteal circulation.

The finding, which was recently published in the journal Nature Metabolism, could help to improve understanding of bone diseases such as osteoporosis and immune system disorders.

Scientists were already aware that a few blood vessels exist at the ends of bones or half way along them, but little is known about how blood enters and leaves long bones.

Given this limited knowledge, Matthias Gunzer and colleagues decided to study blood vessel distribution in the long bones of mice using techniques that have only recently been made available or never been previously used in this field.

Analysis of the lower leg bone using light-sheet fluorescence microscopy and X-ray microscopy showed TCVs crossing the bone shaft, covering the whole bone and constituting most of the bone’s blood supply.

It’s totally crazy there are still things to find out about human anatomy – we have discovered blood vessels in a new place that we didn’t know about before.”

Matthias Gunzer, Study Author

The study also revealed that humans have vessels that resemble TCVs in the thigh bone. Analysis of tiny samples taken from the neck of the human femur identified vessels that were structurally similar to (although much wider than) the ones seen in the mouse model.

Taken together, these data suggest that human long bones, at least in some areas, also possess a system of TCVs that directly connects the vascular system of the BM to the peripheral circulation through cortical bone.”

Gunzer and colleagues point out that diseases affecting bone physiology are known to cause substantial changes in TCV numbers.

“Since key bone pathologies are associated with alterations in the TCV system, entirely new research possibilities that further characterize the role of TCVs in skeletal biology and disease can be envisioned.”

Posted in: Molecular & Structural Biology | Cell Biology | Life Sciences News

#Terapia hormonal poderá combater osteoartrite no joelho na pós-menopausa

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Fonte de imagem: Chicago Health Magazine

A terapia hormonal de substituição poderá ajudar a reduzir a prevalência da osteoartrite do joelho em mulheres na pós-menopausa, indicou um estudo. 

A osteoartrite é a doença músculo-esquelética mais comum nos idosos e a causa principal de incapacidade física e de dores naquele grupo populacional. A doença afeta mais as mulheres e é particularmente prevalente após a menopausa.

O estrogénio possui um efeito anti-inflamatório quando se encontra em concentrações elevadas. Por esse facto, tem-se especulado que as alterações hormonais nas mulheres, especialmente a redução dos níveis de estrogénio, poderão conduzir a uma maior incidência de osteoartrite após a menopausa.

Devido ao facto de os joelhos serem a articulação mais afetada pela doença, foram já conduzidos alguns estudos de pequenas dimensões que demonstraram que a terapia hormonal de substituição reduzia a dor crónica e as alterações histológicas na cartilagem relacionadas com a osteoartrite.

Os tratamentos mais comuns para a osteoartrite no joelho são fármacos anti-inflamatórios não-esteroide e a intervenção cirúrgica. Contudo, ambos os tratamentos podem causar complicações cirúrgicas e gastrointestinais.

Este estudo de grandes dimensões contou com dados de 4.766 mulheres na pós-menopausa, que tinham participado numa sondagem sobre saúde e nutrição na Coreia do Sul.

Os investigadores da Faculdade de Medicina da Universidade da Coreia e do Hospital Universitário Ansan, ambos na Coreia do Sul, observaram que a prevalência da osteoartrite no joelho era significativamente inferior nas mulheres que tinham usado terapia hormonal do que nas que não tinham usado hormonas.

“Este estudo sugere que o estrogénio tomado na menopausa pode inibir a danificação na cartilagem e reduzir a deterioração no joelho observada nos raios-X”, comentou JoAnn Pinkerton, diretora da Sociedade Norte-Americana da Menopausa.

 

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#Estatinas diminuem mortalidade em pacientes com doença reumática?

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estatinas

Estatinas diminuem mortalidade em pacientes com doença reumática?

As doenças reumáticas autoimunes são doenças que, em sua maioria, causam inflamação nas articulações e diminuem a qualidade de vida do paciente. Os tipos mais comuns são esclerodermia, síndrome de Sjögren, miosite, artrite reumatoide, lúpus sistêmico erimatoso, doença de Behçet e fibromialgia. Se não tratadas, podem desencadear em outros problemas futuros. As doenças reumáticas autoimunes estão associadas, inclusive, a um maior risco para o desenvolvimento de eventos cardiovasculares, geralmente potencializados por contantes inflamações e uso de corticoides.

Estatinas como prevenção de eventos cardiovasculares

Uma pesquisa realizada recentemente averiguou os efeitos das estatinas na profilaxia de eventos cardiovasculares causados por essas doenças. O estudo de coorte reuniu registros de um banco de dados britânico, coletados de um centro reumatológico entre 2000 e 2014, e os resultados foram publicados em dezembro de 2018 no The Journal of Reumatology. Os pesquisadores compararam os escores dos participantes medicados com estatinas com os que não receberam o fármaco.

Participaram da pesquisa 4610 pacientes diagnosticados com alguma doença reumática autoimune. Estes foram designados aleatoriamente em dois grupos, o primeiro grupo (n=2305) foi medicado com estatinas e o segundo grupo não iniciou tratamento com o medicamento. O tempo de follow up foi de cinco anos e os desfechos primários observados foram mortalidade.

Mortalidade

Ao final da pesquisa, houve 298 mortes entre os indivíduos medicados com estatinas, já no grupo dos participantes que não receberam profilaxia com o fármaco ocorreram 338 óbitos. A taxa de mortalidade foi de 25,4/100 pessoas por ano vs 30,3/1000 pessoas por ano.

Resultados

Os pesquisadores constataram que o uso de estatinas foi associado a um menor risco de eventos cardiovasculares e mortalidade por todas as causas em pacientes com doenças reumatológicas autoimunes. (HR 0,84, IC 95% [0,72–0,98]).

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All about #ankylosing spondylitis

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Resultado de imagem para espondilite anquilosante

Ankylosing spondylitis is a form of arthritis that mainly affects the spine and sacroiliac joints, or the lower back.

An inflammatory disease, symptoms of ankylosing spondylitis (AS) include pain, stiffness, and loss of mobility. The disease involves erosion of bone and increased bone formation in the spine, leading to bone fusion. In advanced cases, this can lead to spinal deformity.

AS most commonly occurs in men in their teens and 20s, but it can affect anyone of any age. It tends to be milder when it does occur in women, making it harder to diagnose.

Drug treatments and physical therapy can help relieve symptoms.

Fast facts on ankylosing spondylitis (AS):

  • Ankylosing spondylitis is a type of arthritis.
  • It mostly affects the lower part of the spine, and where it joins to the hips, known as the sacroiliac joints.
  • Ankylosing spondylitis can be difficult to diagnose but has a particular pattern of pain symptoms, and changes can be seen on X-ray and MRI.
  • There is no cure, but drugs can help manage the pain and inflammation. Physical therapy can also relieve and prevent some of the effects.

Symptoms

One of the common symptoms of ankylosing spondylitis is lower back pain.

The three main symptoms of AS are:

  • pain
  • stiffness
  • loss of mobility

Pain is the main symptom, especially in the lower back and buttock areas during the early stages.

However, inflammation and pain are not confined to the spine. It is a systemic condition, which means it can affect other parts of the body.

These include:

  • other joints
  • the neck
  • the top of the shin bone in the lower leg
  • behind the heel of the foot, in the Achilles tendon
  • under the heel of the foot

AS can cause so-called bony fusion, an overgrowth of bones at the joints. This can make it difficult to carry out everyday tasks. In some cases, it can restrict movement of the chest and make it hard to breathe.

People with AS may also experience fatigue, a feeling of being tired and lacking energy.

AS can also affect the eyes, including the iris and other parts. This inflammation, known as iritis or uveitis, depending on the location, can cause redness and pain. It can impair vision if not treated.

Other systemic signs of the disease may include neurological and cardiovascular changes.

Below is a 3-D model of ankylosing spondylitis, which is fully interactive.

Explore the model using your mouse pad or touchscreen to understand more about ankylosing spondylitis.

Treatment

There is no cure for AS, and the damage cannot be reversed. However, some options can help relieve symptoms and manage progression.

These include:

  • physical therapies and exercises
  • advice
  • drugs
  • surgery, in rare cases

The person will need to see a specialist doctor, known as a rheumatologist. They may need a number of visits, as the disease progresses slowly. Medical care enables better monitoring and treatment.

Two approaches commonly used to manage AS are:

  • drugs to reduce pain and inflammation
  • physical therapy and exercises to maintain movement and posture

Surgery is used only rarely, in severe cases, to correct severe deformity, such as excessive bending of the spine, or to replace a hip or other joint.

Drug treatment

The main drugs used to ease the pain and inflammation of AS are nonsteroidal anti-inflammatory drugs (NSAIDs). Examples include ibuprofen, naproxen, and diclofenac. Acetaminophen and codeine are also options if NSAIDs are unsuitable or insufficient.

Some NSAIDs compromise bone health by reducing the creation of new bone, and NSAIDs are not usually recommended after surgery for people with bone fusion problems.

Other drug options include:

  • locally injected corticosteroids
  • disease-modifying anti-rheumatic drugs (DMARDs), such as sulfasalazine (brand names: Azulfidine or Sulfazine) and methotrexate (Otrexup, Rheumatrex, or Trexall)
  • tumornecrosis factor (TNF) antagonists, such as adalimumab (Humira), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), or infliximab (Remicade)
  • other biologic treatments, such as secukinumab (Cosentyx)

TNF treatment appears to be effective, but it is expensive and can have adverse effects.

AS can affect the whole body, and patients may meet with a range of specialists, including physical therapists, eye specialists, and gastroenterologists.

Exercises

Physical therapy can help relieve the symptoms of ankylosing spondylitis.

Physical therapy and exercises can help prevent symptoms.

A physical therapist will design a program that can help patients maintain good posture and motion in the joints.

This might include:

  • daily exercises
  • special training
  • therapeutic exercises

Physical therapy exercises are referred to as strengthening exercises and range-of-motion exercises.

Here are two exercises, suggested by the U.K. charity, Arthritis Research:

  1. Stand with your back and heels against a wall, and push your head back to touch the wall. Do not tilt the head back. Hold for 5 seconds, relax, and repeat for up to 10 times.
  2. Stand with the feet apart and hands on hips. Turn to one side, hold for 5 seconds, and relax. Repeat on the other side. Do this five times on each side.

There are different ways to exercise, including water fitness. A doctor can recommend a suitable plan.

Diagnosis

A doctor will ask about symptoms, carry out a physical examination, and arrange for tests where necessary.

If inflammatory back pain is present with certain features, this may indicate AS.

The features include:

  • pain that does not improve with rest
  • pain that causes sleep disturbance
  • back pain that starts gradually, before the age of 40 years, and is not caused by injury
  • symptoms that persist for over 3 months
  • spinal stiffness in the mornings, which improves with exercise and motion

Imaging tests may confirm the diagnosis, but changes may not be immediately visible on such tests. This can delay diagnosis.

Blood tests

No blood test can confirm AS, but tests can help confirm diagnosis and rule out other causes.

The tests for inflammation may include:

  • erythrocyte sedimentation rate (ESR)
  • C-reactive protein (CRP)
  • complete blood count (CBC)
  • genetic test (HLA B27)

If other causes, such as rheumatoid arthritis (RA) are suspected, testing for rheumatoid factor (RF), cyclic citrullinated peptide (CCP), and antinuclear antibodies (ANA) can help rule out these conditions.

Imaging tests

These may include:

  • X-rays, which can reveal both early and more advanced changes to the spine and pelvis
  • MRI, for example, an MRI of sacroiliac (SI) joints can reveal early signs of the condition

Causes

The exact cause of AS remains unclear, but the symptoms result from inflammation in parts of the lower spine.

When new bone grows, this inflammation can lead to damage and fusion. The fusion can happen as a result of the inflammation of the tissues that connect to bones.

However, it is not yet known why this chronic inflammatory process occurs in people with ankylosing spondylitis.

The condition often runs in families and is known to have a genetic component.

Outlook

The prognosis for AS is difficult to predict, as it varies widely between individuals, and the progression is often not constant.

Important factors for measuring outlook include levels of functional ability, spinal mobility, joint damage, and so on. Some people will experience severe functional loss, some hardly notice their symptoms, and around 1 percent experience remission, where symptoms cease to develop.

A few people will have life-threatening complications, affecting the heart, lungs, or intestines.

Males who develop symptoms at a younger age are more likely to have severe damage and loss of mobility, but in women, the impact appears to be less severe.

Smoking has been linked to poorer outcomes.

#Dieta mediterrânea associada a um menor risco de #artrite reumatoide

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De acordo com um estudo publicado on-line em 09 de agosto no Arthritis Research & Therapy, a alta adesão à pontuação da dieta mediterrânea está associada a um menor risco de artrite reumatoide (AR) em algumas populações.

Kari Johansson, Ph.D., do Karolinska Institutet em Estocolmo, e colegas usaram dados da investigação epidemiológica de AR na Suécia para identificar 1.721 pacientes com AR incidental (casos) e 3.667 controles, pareados por idade, sexo e região de residência. A pontuação da dieta mediterrânea foi determinada com base em um questionário sobre a frequência de 124 itens alimentares.

Os pesquisadores observaram que 24,1% dos pacientes e 28,2% dos controles tinham alta adesão à dieta mediterrânea (uma pontuação entre 6 e 9 em uma escala de 9 pontos). A alta adesão à dieta reduziu o risco de desenvolver AR em 21% (razão de chances [odds ratio, OR]: 0,79; intervalo de confiança [IC] de 95%: 0,65 a 0,96) em comparação à baixa adesão (uma pontuação entre 0 e 2), depois de ajustar para o índice de massa corporal, nível educacional, atividade física, uso de suplementos nutricionais, ingestão de calorias e tabagismo. No caso dos homens, a OR foi ainda menor (OR: 0,49; IC de 95%: 0,33 a 0,73), mas não houve associação significativa nas mulheres (OR: 0,94; IC de 95%: 0,74 a 1,18). Houve uma associação entre a pontuação alimentar alta e um baixo risco de AR na presença de fator reumatoide positivo (OR: 0,69; IC de 95%: 0,54 a 0,88), mas não na presença de fator reumatoide negativo (OR: 0,96; IC de 95%: 0,68 a 1,34).

“Precisamos reconhecer que os mecanismos e o impacto de possíveis diretrizes nutricionais podem ser diferentes em diferentes subgrupos de AR”, escreveram os autores.

#Foot and Ankle #Osteoarthritis

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As you age, your chance of developing osteoarthritis, which is caused by wear and tear, increases. The joint damage associated with osteoarthritis causes swelling, pain, and deformity. Here is information about how osteoarthritis affects the foot and ankle and information you can use to help you manage this debilitating condition.

What Is Arthritis?

Arthritis is a general term for a group of more than 100 diseases. The word “arthritis” means “joint inflammation.” Arthritis involves inflammation and swelling in and around the body’s joints and surrounding soft tissue. The inflammation can cause pain and stiffness.

In many kinds of arthritis, progressive joint deterioration occurs and the smooth “cushioning” cartilage in joints is gradually lost. As a result, the bones rub and wear against each other. Soft tissues in the joints also may begin to wear down. Arthritis can be painful and eventually result in limited motion, loss of joint function, and deformities in the joints affected.

What Is Osteoarthritis?

Osteoarthritis, or “wear-and-tear” arthritis, is the most common type of arthritis. Also known as degenerative joint disease or age-related arthritis, osteoarthritis is more likely to develop as people age. Inflammation and injury to the joint cause a breaking down of cartilage tissues, resulting in pain, swelling, and deformity. The changes in osteoarthritis usually occur slowly over many years, though there are occasional exceptions.

How Does Osteoarthritis Affect the Foot and Ankle?

Each foot has 28 bones and more than 30 joints. The following are the most common foot joints affected by osteoarthritis:

  • The three joints of the foot that involve the heel bone, the inner mid-foot bone, and the outer mid-foot bone
  • The joint of the big toe and foot bone
  • The joint where the ankle and shinbone meet

What Are the Symptoms of Foot and Ankle Osteoarthritis?

Symptoms of foot and ankle osteoarthritis often include:

  • Tenderness or pain
  • Reduced ability to move, walk, or bear weight
  • Stiffness in the joint
  • Swelling in the joint

How Is Foot and Ankle Osteoarthritis Diagnosed?

The diagnosis of foot and ankle osteoarthritis most likely will involve:

How Is Foot and Ankle Osteoarthritis Treated?

Foot and ankle osteoarthritis can be treated in many ways. Nonsurgical methods to treat foot and ankle arthritis include:

  • Steroid medicationsinjected into the joints
  • Anti-inflammatory drugs to reduce swelling in the joints
  • Pain relievers
  • Pads or arch supports
  • Canes or braces to support the joints
  • Inserts that support the ankle and foot (orthotics)
  • Physical therapy
  • Custom shoes
  • Weight control

Tips on Foot Care With Osteoarthritis

The most essential element of foot care for people with foot and ankle osteoarthritis is to wear shoes that fit properly and feel comfortable. The following are things to look for in finding a comfortable shoe:

  • Shoes shaped like your foot
  • Shoes that have support — for example, no slip-on shoes
  • Rubber soles to provide more cushioning
  • Flexibility
  • Proper fit — ask the salesperson to help you with this

Exercise can help keep your feet pain-free, strong, and flexible. Exercises that can be good for your feet include:

  • Achilles stretch. With your palms flat on a wall, lean against the wall and place one foot forward and one foot back. Lean forward, leaving your heels on the floor. You can feel the pull in your Achilles tendon and your calf. Repeat this exercise three times, holding for 10 seconds on each repeat.
  • Big-toe stretch. Place a thick rubber band around your big toes. Pull the big toes away from each other and toward the other toes. Hold this position for five seconds and repeat the exercise 10 times.
  • Toe pull. Place a rubber band around the toes of each foot, and then spread your toes. Hold this position for five seconds and repeat the exercise 10 times.
  • Toe curl. Pick up marbles with your toes.

Is Surgery an Option for Foot and Ankle Osteoarthritis?

More than one kind of surgery may be required to treat foot and ankle osteoarthritis. Your doctor can select the kind of surgery that is best for you, depending on the extent of your arthritis. The following are some of the surgical options for foot and ankle osteoarthritis:

  • Fusion surgery. This kind of surgery, also called arthrodesis, involves fusing bones together with the use of rods, pins, screws, or plates. After healing, the bones remain fused together.
  • Joint replacement surgery. This kind of surgery involves replacing the ankle joint with artificial implants and is used only in rare cases.

#Veja as novas recomendações de atividade física para pacientes com artrite

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artrite

Veja as novas recomendações de atividade física para pacientes com artrite

 

A Liga Europeia Contra Reumatismo (EULAR, em inglês) lançou recentemente o trabalho da força-tarefa (FT) sobre as recomendações de atividade física em pacientes com artrites (artrite reumatoide, osteoartrite de quadril/joellho e espondiloartrite) após revisão da literatura médica sobre o assunto. Pontos importantes envolvem o potencial beneficio da prática regular no aspecto de reduzir a “atividade” de doença e ajudar no controle do peso corporal, reduzindo a carga imposta na articulação.

Atualmente, os dados da literatura mostram que os pacientes com tais problemas são mais sedentáriosque a média, talvez por medo de piorar dos sintomas e/ou de lesão. Só que isso pode também refletir que os profissionais de saúde têm que ser informados para melhor encorajar a prática quando indicado. O benefício do exercício não se restringiria a melhorar os “doentes”, atuando também na prevenção.

Vamos aos keypoints dessa FT após análise da literatura:

  • Atividade física é parte integral do cuidado.
  • Todo profissional de saúde deve estar envolvido no processo (abordagem multidisciplinar).
  • Capacitação dos profissionais de saúde para orientar corretamente os pacientes.
  • Definir status (ativo/ não ativo) e nos diferentes domínios (cardiorrespiratório, força muscular, flexibilidade e neuromotor).
  • Contraindicações gerais e específicas para cada doença.
  • Individualizar os alvos da terapia com exercício e avaliação com questionários estabelecidos.
  • Barreiras e facilitadores gerais e específicos de cada doença.
  • Adaptação individualizada após avaliação minuciosa.
  • Aplicar técnicas de mudança de comportamento.
  • Modos de prática (terrestre, água, supervisionada, individual).

A opinião da FT é que a maioria dos pacientes com artrites têm condição de praticar atividade física regular quase como uma pessoa sem tais doenças, de modo a atingir o que é recomendado pela OMS. Os benefícios parecem ser diversos e é preciso implementar um processo de orientação/avaliação/encorajamento para atingir o objetivo e com boa adesão dos pacientes após avaliação multidisciplinar individualizada.

 

Autor:

Cristiano Carvalho de Oliveira

Formado em Medicina pela UFRJ em 2009/2 ⦁ Residência de Clínica Médica no HUCFF (UFRJ 2010 -2012) ⦁ Residência de Cardiologia no HUCFF (UFRJ 2012 – 2014) ⦁ Trabalho na Emergência do H. Pró-cardíaco ⦁ Ergometrista na CardioClin.

Referências:

 

 

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