CLAUDIA GOLDENSTEIN SCHAINBERG

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LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina

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Autor e Coautores FMUSP-HC Normalizados: RICARDO FULLER ×

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  • conferenceObject
    CHRONIC EFFECTS OF A FLEXIBLE AND MINIMALIST FOOTWEAR ON CLINICAL, FUNCTIONAL AND GAIT BIOMECHANICAL ASPECTS IN THE KNEE OSTEOARTHRITIS: A SINGLE-BLIND RANDOMIZED CLINICAL TRIAL
    (2012) TROMBINI-SOUZA, F.; MATIAS, A.; YOKOTA, M.; SCHAINBERG, C.; FULLER, R.; SACCO, I. C.
    Purpose: Recent studies have shown that the acute use of shoes that mimic barefoot gait decrease substantially knee loads while walking in elderly with knee osteoarthritis (OA). Probably due to methodological difficulties to implement this type of conservative treatment during extended period, the effectiveness of minimalist footwear has not been evaluated yet in elderly patients with knee OA. The purpose is to describe a randomized clinical trial protocol for evaluating the therapeutic effect of a minimalist (flexible, non-heeled) and inexpensive footwear on clinical, functional, and biomechanical gait in elderly women with knee OA. Methods: Fifty six elderly women with knee OA grade 2 or 3 (Kellgren and Lawrence) will be randomized in blocks and allocated in the intervention group that will use a flexible non-heeled shoes- Moleca® forat least 6 hours daily or in the control group, which could not use these shoes or be under physical therapy or acupuncture treatment throughout these sis months. The use of Paracetamol 500 mg every six hour was allowed for both groups in case of pain. Moleca® (Calçados Beira Rio S.A., Novo Hamburgo, RS, Brazil) is a women's double canvas flexiblefl at walking shoe without heels, with a 5-mm anti-slip rubber sole and a 3-mm internal wedge of ethylene vinyl acetate. The mean weight is 172±19.6 g, ranging from 142 to 193 g depending on the size. Both groups will be followed during 6 months. They will be assessed at baseline condition, after 3 months (intervention group) and after 6 months of baseline condition(end of intervention, both groups). All the assessments will be performed by a physiotherapist that is blind to which group thepatient was allocated. The main outcome assessmentis the pain WOMAC score and the secondary outcomes are other WOMAC scores pain assessment (visual analogue scale - VAS), Lequesne index, Six-Minute Walk Test, and biomechanical gait analysis by means of 6 infrared cameras and a multi-component force plate to determine the knee adduction moment during gait. At baseline, all patients receive a diary to record the hours of daily use of footwear intervention. Every two weeks, the same physiotherapist carries phone calls to all patients in order to verify adherence to treatment and the correct filling this diary. Theinter group andinter-moments will be performed by repeated measures analysis of variance (α=0.05). This Trial was approved by the local Ethics Committee and was registered in ClinicalTrials.gov Identifier: NCT01342458. Results: Six hundred thirty-four elderly women have been contacted so far and 20 have already been allocated in the intervention group (9) and in the control (11). Five patients from intervention group have already completed all 3 assessments and finished the protocol. The preliminary results have shown that the elderly women of the intervention group have used the Moleca® shoe for an average monthly of 7 hours and 24 minutes (±3:47), corresponding to approximately 50% of the home-work hours of the day. Conclusion: This is the first randomized clinical trial protocol to assess the chronic effect of a minimalist footwear on the clinical, functional and gait biomechanics of elderly women with knee osteoarthritis. We expect that the use of Moleca® shoes for 6 months provides pain relief, reduction of the knee adduction moment while walking and improves joint function in elderly women with knee OA, and therefore can be considered as another inexpensive option for conservative OA treatment. The authors are pleased to acknowledge the financial support of State of São Paulo Research Foundation - FAPESP (processes: 2011/01640-8, 2011/03300-0, 2011/03069-6).
  • conferenceObject
    EFFECTIVENESS OF LONG-TERM USE OF MINIMALIST FOOTWEAR ON PAIN AND FUNCTION IN KNEE OSTEOARTHRITIS
    (2013) GOLDENSTEIN-SCHAINBERG, Claudia; FULLER, Ricardo; MATIAS, Alessandra; YOKOTA, Mariane; BUTUGAN, Marco; TROMBINI-SOUZA, Francis; SACCO, Isabel
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    COLLAGEN TYPE V FACILITATE THE DIFFERENTIATION OF RABBIT ADIPOSE TISSUE-DERIVED STEM CELLS INTO A CHONDROCYTE-LIKE PHENOTYPE ""IN VITRO""
    (2012) CRUZ, Isabele B.; GOLDENSTEIN-SCHAINBERG, C.; FULLER, R.; VELOSA, A. P.; CARRASCO, S.; CAPELOZZI, V.; YOSHINARI, N. H.; TEODORO, W. R.
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    SPINAL LESIONS DUE TO TOPHACEOUS GOUT - A DIFFERENTIAL DIAGNOSIS NOT RELATED TO SYMPTOMS
    (2013) MELLO, F. M.; GOLDENSTEIN-SCHAINBERG, C.; FULLER, R.; HALPERN, A. S.
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    Metabolic Syndrome: The Genesis of Nephrolithiasis in Gout Patients?
    (2012) MELLO, Filipi M.; TOMITA, Rafael B.; FULLER, Ricardo; FILHO, Marco Antonio G. P.; BARROS, Thiago B. M.; PRADO, Leandro L. do; AUGUSTO, Kristopherson L.; GOLDENSTEIN-SCHAINBERG, Claudia
    Background/Purpose: Gout patients have a high frequency of metabolic syndrome (MS), a disorder known to be associated with hyperinsulinemia. The latter condition augments proximal tubular sodium reabsorption and leads to reduced renal urate excretion and hyperuricemia. There are no data, however, evaluating whether MS can influence gout-associated clinical characteristics. Thus, we aimed to determine the prevalence of MS in our population and to investigate if the presence of MS would characterize a particular clinical and laboratorial gout profile. Methods: This was a cross-sectional study of 158 gout patients (ACR criteria). MS was defined in accordance to the National Cholesterol Education Program ATP III (NCEP-ATP III) and the International Diabetes Federation (IDF) criteria. Demographic, anthropometric (body mass index - BMI) and clinical data were evaluated. Fasting serum levels of UA, glucose, triglycerides and cholesterol fractions were analyzed by routine laboratory tests. Nephrolithiasis was demonstrated by usual ultrasonography and urate under-excretion defined as UA clearance lower than 7.5 ml/min. Statistical comparisons were performed using Fisher’s exact, chi-square, students T and Spearman’s tests and P<0.05 was considered significant. Results: The frequency of MS in gout patients was 73% and 71% according to NCEP ATPIII and IDF criteria respectively. Further comparison of 125 patients with MS and those 33 without this condition revealed similar mean ages (63.0 ± 11.5 vs 62.5 ± 12.9; p>0,05) and male predominance (94% and 75%). As expected, those with MS had higher BMI (30.2 ± 5.5kg/m2 vs 27.0 5.8kg/m2; p=0.005) and higher prevalences of systemic arterial hypertension (93.3% vs 75% p=0.012) and diabetes (25.8% vs 0, p=0.001), though comparable frequency of coronary artery disease (22.5% vs 16.7%; p=0.469). With regard to gout clinical/laboratorial characteristic, patients with MS had more nephrolitiasis (37.1% vs 16.7%, p=0.026), but they did not differ from patients without MS concerning the presence of tophi (52.8% vs. 55.6%; p = 0.780) or uric acid underexcretion (83.1% vs 94.4%; p=0.148). Current alcohol consumption, mean estimated creatinine clearance and mean serum levels of uric acid, were alike in both groups (p>0.05). Conclusion: The novel demonstration that MS in gout is associated to nephrolithiasis suggests that this condition may underlie the genesis of uric acid stones. Whether insulin resistance may account for a renal alteration that may ultimately impair buffering and amplification of acidic urine remains to be determined. Moreover, the elevated prevalence of MS in gout patients from our country (almost 3⁄4) is higher than overall rates of 63% MS in gout worldwide, indicating possible influence of dietary, geographical and/or genetic background.
  • article 9 Citação(ões) na Scopus
    Increased prevalence of simple renal cysts in patients with gout
    (2013) HASEGAWA, Eduardo Massato; FULLER, Ricardo; CHAMMAS, Maria Cristina; MELLO, Filipe Martins de; GOLDENSTEIN-SCHAINBERG, Claudia
    The aim of this study was to determine the prevalence of simple renal cysts in gout patients and evaluate associated risk factors for its development. Hundred and forty-six patients followed at our outpatient Gout Unit and 47 sex- and age-matched healthy kidney donors who had undergone routine renal ultrasonography, using a static gray scale and real-time B-mode units with a 3.5- or 5.0-MHz transducer, were evaluated for the presence of renal cysts. Demographic and clinical characteristics of gout patients were evaluated considering possible risk factors for the occurrence of simple renal cysts such as age, male gender, hypertension, and renal impairment. The prevalence of simple renal cyst was 26.0 % in gout patients and 10.6 % in control group (P = 0.045). Gout patients with simple renal cysts presented less renal lithiasis than those without this complication (5.2 vs 25.9 %; P = 0.003) in spite of an overall higher frequency of renal stones in gout patients compared to control group (20.5 vs. 6.3 %, P = 0.025). The presence of simple renal cyst in gout was not associated with previously reported factors such as age (P = 0.296), male predominance (P = 0.688), hypertension (P = 0.314), and renal impairment (P = 254). Moreover, no association with disease duration (P = 0.843) or tophi (P = 0.616) was observed. In conclusion, gout patients have an increased prevalence of simple renal cysts associated with a lower occurrence of nephrolithiasis. Whether renal cysts have any protective effect in the development of nephrolithiasis in gout remains to be determined.
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    Collagen V induces differentiation of rabbit adipose tissue-derived stem cells in chondrocyte-like phenotype
    (2012) TEODORO, W.; CRUZ, I. Brindo da; VELOSA, A. P.; CARRASCO, S.; GOLDENSTEIN-SCHAINBERG, C.; FULLER, R.; PARRA, E.; CAPELOZZI, V.
    Objective: Stimulated mesenchymal stem cells (MSCs) have capacity of differentiation in many cell types. It is being used in degenerative diseases treatment protocols. We evaluated the collagen V (COL V) and collagen XI (COL XI) influence in the differentiation of rabbits adipose tissue-derived MSCs in a chondrocyte-like cell phenotype. Method: MSCs isolated of New Zealand rabbits adipose-tissue were maintained in culture by 4 weeks. COLV, COLXI and COLV/XI (10μg/ml) were added to culture during 72 h. The cells aggregates were stained with Toluidine blue, Alcian blue and Picrosirius. Chondrocyte-like phenotype was confirmed by immunofluorescence to CD34, vimentin and collagens I, II and III. Results: MSCs stimulated with COLV expressed proteoglicans and collagen, when compared with COLXI and COLV/XI and control. In the presence of COLV, MSCs was capable to increase collagen II expression confirming its chondro-cyte-like cell phenotype. In contrast, MSCs cultured with COLXI and COLV/XI express collagen I and III. Conclusion: The data suggest that COLV may facilitate the differentiation of rabbit adipose tissue-derived stem cells into a chondrocyte-like phenotype. Further studies are urged in order to evaluate the influence of COLV in the ability of chondrocytes to remodel osteoarthritic joint surface at ultrastructural and molecular levels.
  • article 8 Citação(ões) na Scopus
    Nephrolithiasis in gout: prevalence and characteristics of Brazilian patients
    (2019) HOFF, Leonardo Santos; GOLDENSTEIN-SCHAINBERG, Claudia; FULLER, Ricardo
    Background The aims of this article were to assess the prevalence of nephrolithiasis and the factors associated with nephrolithiasis in Brazilian patients with primary gout. Methods One hundred twenty-three patients with primary gout were recruited from a tertiary referral hospital in Sao Paulo, Brazil. All patients underwent ultrasonography and had their clinical and laboratory characteristics assessed. Results One hundred fifteen (93.5%) patients were male, with a mean age of 62.9 +/- 9.4 years. Twenty-three (18.7%) patients had asymptomatic nephrolithiasis (detected only by ultrasonography), 7 (6.0%) had symptomatic nephrolithiasis (detected by ultrasonography and a positive clinical history), and 13 (10.0%) had a history of kidney stones, but ultrasonography at evaluation did not show nephrolithiasis. Therefore, 35.0% of the patients had nephrolithiasis (detected either by ultrasonography and/or a positive clinical history). Nephrolithiasis was associated with male gender (43 [100%] vs 72 [90%], p = 0.049), the use of potassium citrate (13 [30.2%] vs 0, p < 0.001) and the use of medications for diabetes (10 [23.3%] vs 8 [10%], p = 0.047) and dyslipidemia (15 [34.9%] vs 10 [12.5%], p = 0.003); benzbromarone had an inverse association with nephrolithiasis (21 [48.8%] vs 55 [68.8%], p = 0.030). In patients with and without nephrolithiasis, no differences were found in the laboratory and ultrasonography characteristics, including serum uric acid levels, urinary uric acid excretion and urine pH. Conclusions The prevalence of nephrolithiasis in primary gout was 35.0%, and 18.7% of the patients were asymptomatic. Nephrolithiasis was associated with male gender, diabetes and dyslipidemia. A positive history of nephrolithiasis probably biased the prescription of potassium citrate and benzbromarone.
  • conferenceObject
    LOW COST MINIMALIST SHOE AS A MECHANICAL TREATMENT FOR ALGO-FUNCTIONAL ASPECTS AND ANALGESIC MEDICINE INTAKE IN ELDERLY WOMEN WITH KNEE OSTEOARTHRITIS
    (2014) TROMBINI-SOUZA, F.; MATIAS, A.; YOKOTA, M.; SCHAINBERG, C.; FULLER, R.; SACCO, I. C.
  • article 5 Citação(ões) na Scopus
    Long-term use of minimal footwear in older adult women with knee osteoarthritis: Mechanisms of action in the knee adduction moment
    (2020) TROMBINI-SOUZA, Francis; FULLER, Ricardo; GOLDENSTEIN-SCHAINBERG, Claudia; SACCO, Isabel C. N.
    Studies have shown the short- and long-term effects of wearing minimalist footwear in reducing knee loads in patients with knee osteoarthritis (OA). This study aimed to investigate the mechanisms underpinning the reduction in external knee adduction moment (EKAM) in older adult women who wore this type of footwear through a randomized controlled trial. Fifty-six participants with medial compartment knee OA were equally allocated to either an intervention group (IG) that wore minimalist footwear (Moleca (R)) or to a control group (CG) that continued regular clinical treatment for OA for six months. The influence of lower limb joint kinematics and joint frontal moments, center of pressure displacement, and foot progression angle in predicting the reduction of EKAM were assessed after a six-month intervention. Surprisingly, none of the seven independent variables predicted the first peak EKAM in the multiple regression model for the 1G. For the CG, the increase of one unit in the first peak of the hip adduction moment resulted in a 1.01 units increase in the first peak EKAM. Additionally, a one-unit reduction in the ankle eversion angle resulted in an increase of 0.16 units in the percent change in the first peak EKAM. Thus, wearing the Moleca (R) shoe for six months helped the participants keep a natural gait pattern without increasing the hip moment or the ankle inversion angle compared to the women who did not wear the Moleca (R) footwear.