CLAUDIA GOLDENSTEIN SCHAINBERG
Projetos de Pesquisa
Unidades Organizacionais
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina
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- Management of Peripheral Arthritis in Patients With Psoriatic Arthritis: An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations(2023) LEUNG, Ying-Ying; KOROTAEVA, Tatiana V.; CANDIA, Liliana; PEDERSEN, Susanne Juhl; MOLANO, Wilson Bautista; RUDERMAN, Eric M.; BISOENDIAL, Radjesh; PEREZ-ALAMINO, Rodolfo; OLSDER, Wendy; MOELLER, Burkhard; GRAZIO, Simeon; GUDU, Tania; MODY, Girish M.; PINEDA, Carlos; RAFFAYOVA, Helena; ROHEKAR, Sherry; GOLDENSTEIN-SCHAINBERG, Claudia; URENA, Sergio R. Gutierrez; VARGAS, Julio Cesar Casasola; MEGHNATHI, Bhowmik; PRASAD, Roopa; RICHETTE, Pascal; MIRANDA, Jose Roberto S.; MALLIOTIS, Nikolas; LINDQVIST, Ulla; SIMON, David; EZEONYELI, Amara; SORIANO, Enrique R.; FITZGERALD, OliverObjective. We aimed to compile evidence for the efficacy and safety of therapeutic options for the periph-eral arthritis domain of psoriatic arthritis (PsA) for the revised 2021 Group in Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations. Methods. A working group consisting of clinicians and patient research partners was convened. We reviewed the evidence from new randomized controlled trials (RCTs) for PsA treatment from February 19, 2013, to August 28, 2020. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-informed approach to derive evidence for the classes of therapeutic options for 3 patient groups: (1) naive to treatment, (2) inadequate response to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), and (3) inadequate response to biologic DMARDs (bDMARDs). Recommendations were derived through consensus meetings. Results. The evidence review included 69 RCTs. We derived GRADE evidence for each class of therapeutic options and achieved consensus for the recommendations. For patients naive to treatment, the working group strongly recommends csDMARDs (methotrexate, sulfasalazine, leflunomide) and phosphodi-esterase 4 inhibitors, and emphasizes regular assessment and early escalation to achieve treatment target. bDMARDs (tumor necrosis factor inhibitors [TNFi], interleukin 17 inhibitors [IL-17i], IL-12/23i, IL-23i) and Janus kinase inhibitors (JAKi) are also strongly recommended. For patients with inadequate response to csDMARDs, we strongly recommend TNFi, IL-17i, IL-12/23i, IL-23i, and JAKi. For those who had prior experience with bDMARDs, we strongly recommend a second TNFi, IL-17i, IL-23i, and JAKi. The evidence supporting nonpharmacological interventions was very low. An expert panel conditionally recom-mends adequate physical activity, smoking cessation, and diet to control weight gain. Conclusion. Evidence supporting optimal therapy for the peripheral arthritis domain of PsA was compiled for the revised 2021 GRAPPA treatment recommendations.
- Brazilian Society of Rheumatology 2020 guidelines for psoriatic arthritis(2021) CARNEIRO, Sueli; PALOMINOS, Penelope Esther; ANTI, Sonia Maria Alvarenga; ASSAD, Rodrigo Luppino; GONCALVES, Rafaela Silva Guimaraes; CHIEREGHIN, Adriano; LYRIO, Andre Marun; XIMENES, Antonio Carlos; SAAD, Carla Goncalves; GONCALVES, Celio Roberto; KOHEM, Charles Lubianca; MARQUES, Claudia Diniz Lopes; SCHAINBERG, Claudia Goldenstein; MEIRELLES, Eduardo de Souza; RESENDE, Gustavo Gomes; PIERUCCETTI, Lenise Brandao; KEISERMAN, Mauro Waldemar; YAZBEK, Michel Alexandre; SAMPAIO-BARROS, Percival Degrava; LAGE, Ricardo da Cruz; BONFIGLIOLI, Rubens; OLIVEIRA, Thauana Luiza; AZEVEDO, Valderilio Feijo; BIANCHI, Washington Alves; BERNARDO, Wanderley Marques; SIMOES, Ricardo dos Santos; PINHEIRO, Marcelo de Medeiros; CAMPANHOLO, Cristiano BarbosaPsoriatic arthritis (PsA) is a chronic and systemic immune disease characterized by inflammation of peripheral and/or axial joints and entheses in patients with psoriasis (PsO). Extra-articular and extracutaneous manifestations and numerous comorbidities can also be present. These recommendations replace the previous version published in May 2013. A systematic review of the literature retrieved 191 articles that were used to formulate 12 recommendations in response to 12 clinical questions, divided into 4 sections: diagnosis, non-pharmacological treatment, conventional drug therapy and biologic therapy. These guidelines provide evidence-based information on the clinical management for PsA patients. For each recommendation, the level of evidence (highest available), degree of strength (Oxford) and degree of expert agreement (interrater reliability) are reported.
- Current and relevant concepts in psoriatic arthritis(2012) GOLDENSTEIN-SCHAINBERG, Claudia; FAVARATO, Maria Helena Sampaio; RANZA, RobertoPsoriatic arthritis (PsA) is a systemic, polymorphic joint disease with variable presentation and clinical course. The outcome depends on the association with severe comorbidities such as diabetes, hypertension and dyslipidemia. Early diagnosis requires a high degree of clinical suspicion, especially when skin manifestations are subtle and poorly defined. Progressive erosive disease can occur in up to half of patients, associated with anatomical and functional changes in about 20%. Thus, the prognosis of PsA remains unclear, especially if diagnosis and treatment are delayed. Based on extensive literature review (PubMed and Lilacs) and experience of our services, new concepts of immunogenetics, pathophysiology, and clinical and therapeutic aspects are discussed. Factors that reduce the quality of life and life expectancy of patients, as well as new guidelines for treatment, will be emphasized. Control of inflammation, especially in enthesitis and axial forms of PsA, was made possible due to the introduction of anti-TNF biologics. Finally, the role of GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) should be emphasized, since it promotes meetings and joint studies between rheumatologists and dermatologists to provide scientific evidence for the sweeping changes in clinical management and treatment of patients with PsA.
- Abnormal collagen V deposition in dermis correlates with skin thickening and disease activity in systemic sclerosis(2012) MARTIN, Patricia; TEODORO, Walcy R.; VELOSA, Ana Paula P.; MORAIS, Jymenez de; CARRASCO, Solange; CHRISTMANN, Romy B.; GOLDENSTEIN-SCHAINBERG, Claudia; PARRA, Edwin R.; KATAYAMA, Maria Lucia; SOTTO, Mirian N.; CAPELOZZI, Vera L.; YOSHINARI, Natalino H.Objective: The physiological and mechanical properties of the skin, the primary tissue affected by systemic sclerosis, depend on the assembly of collagen types I, Ill and V, which form heterotypic fibers. Collagen V (COLV) regulates heterotypic fiber diameter, and the maintenance of its properties is important for maintaining normal tissue architecture and function. Based on a COLV-induced experimental SSc model, in which overexpression of abnormal COLV was a prominent feature, we assumed that this abnormality could be present in SSc patients and could be correlated to disease duration, skin thickening and disease activity. Methods: Skin biopsies from 18 patients (6 early-stage and 12 late-stage) and 10 healthy controls were studied. Skin thickening assessment was performed with the Modified Rodnan Skin Score (MRSS), and activity was calculated using the Valentini Disease Activity Index. Morphology, morphometry of COLV deposition in dermis, as well as, quantitative RT-PCR and 3D-reconstruction of the dermal fibroblast culture were performed. Results: Structurally abnormal COLV was overexpressed in SSc skin, mainly in the early stages of the disease, when compared to normal controls and late-stage. A positive correlation between COLV expression and MRSS and disease activity was observed. Collagen V alpha-1 and alpha-2 mRNA expression levels were higher in SSc. Tridimensional reconstruction of SSc dermal heterotypic fibers confirmed the presence of atypical COLV. Conclusion: Increased synthesis of abnormal COLV and its correlation with disease stage, activity and MRSS suggest that this collagen can be a possible trigger involved in the pathogenesis of SSc.