EDUARDO DE SOUZA MEIRELLES

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Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina

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  • article 0 Citação(ões) na Scopus
    Enteropathic arthritis in Brazil: data from the Brazilian registry of spondyloarthritis (vol 53, pg 452, 2013)
    (2014) RESENDE, Gustavo G.; LANNA, Cristina C. D.; BORTOLUZZO, Adriana B.; GONCALVES, Celio R.; SAMPAIO-BARROS, Percival D.; SILVA, Jose Antonio Braga da; XIMENES, Antonio Carlos; BERTOLO, Manoel B.; RIBEIRO, Sandra L. E.; KEISERMAN, Mauro; MENIN, Rita; SKARE, Thelma L.; CARNEIRO, Sueli; AZEVEDO, Valderilio F.; VIEIRA, Walber P.; ALBUQUERQUE, Elisa N.; BIANCHI, Washington A.; BONFIGLIOLI, Rubens; CAMPANHOLO, Cristiano; CARVALHO, Hellen M. S.; COSTA, Izaias P.; DUARTE, Angela P.; KOHEM, Charles L.; LEITE, Nocy; LIMA, Sonia A. L.; MEIRELLES, Eduardo S.; PEREIRA, Ivanio A.; PINHEIRO, Marcelo M.; POLITO, Elizandra; ROCHA, Francisco Airton C.; SANTIAGO, Mittermayer B.; SAUMA, Maria de Fatima L. C.; VALIM, Valeria
  • article 17 Citação(ões) na Scopus
    Baixa prevalência das manifestações extra-articulares renais, cardíacas, pulmonares e neurológicas nas espondiloartrites: análise do Registro Brasileiro de Espondiloartrites
    (2012) RODRIGUES, Carlos Ewerton Maia; VIEIRA, Walber Pinto; BORTOLUZZO, Adriana B.; GONÇALVES, Célio Roberto; SILVA, José Antonio Braga da; XIMENES, Antonio Carlos; BÉRTOLO, Manoel B.; RIBEIRO, Sandra L. E.; KEISERMAN, Mauro; MENIN, Rita; SKARE, Thelma L.; CARNEIRO, Sueli; AZEVEDO, Valderílio F.; ALBUQUERQUE, Elisa N.; BIANCHI, Washington A.; BONFIGLIOLI, Rubens; CAMPANHOLO, Cristiano; CARVALHO, Hellen M. S.; COSTA, Izaias P.; DUARTE, Angela P.; KOHEM, Charles L.; LEITE, Nocy H.; LIMA, Sonia A. L.; MEIRELLES, Eduardo S.; PEREIRA, Ivânio A.; PINHEIRO, Marcelo M.; POLITO, Elizandra; RESENDE, Gustavo G.; ROCHA, Francisco Airton C.; SANTIAGO, Mittermayer B.; SAUMA, Maria de Fátima L. C.; VALIM, Valeria; SAMPAIO-BARROS, Percival D.
    OBJECTIVE: To describe the extra-articular manifestations (cardiac, renal, pulmonary, and neurological), usually not related to spondyloarthritis (SpA), in a large cohort of Brazilian patients. MATERIALS AND METHODS: This retrospective study analyzed 1,472 patients diagnosed with SpA and cared for at 29 health care centers distributed in the five major geographic regions in the country, participating in the Brazilian Registry of Spondyloarthritis (BRS). All patients were assessed for the prevalence of major extra-articular manifestations (cardiac, renal, pulmonary, and neurological), classified according to the diagnosis [ankylosing spondylitis (AS), psoriatic arthritis (PsA), reactive arthritis (ReA), arthritis associated with inflammatory bowel disease (IBD), undifferentiated spondyloarthritis (uSpA), and juvenile SpA], and according to the clinical presentation (axial, peripheral, mixed, and enthesitis). RESULTS: Of the patients with SpA assessed, 963 had AS, 271 PsA, 49 ReA, 48 arthritis associated with IBD, 98 uSpA, and 43 juvenile SpA. Cardiac involvement was reported in 44 patients (3.0%), pulmonary involvement in 19 (1.3%), renal involvement in 17 (1.2%), and neurological involvement in 13 patients (0.9%). Most patients with visceral involvement had AS or PsA, and the mixed (axial + peripheral) and/or predominantly axial clinical form. CONCLUSION: Cardiac, renal, pulmonary, and neurological extra-articular manifestations are quite infrequent in SpA, ranging from 0.9% to 3% in this large Brazilian cohort, and affected predominantly patients with AS and PsA.
  • article 33 Citação(ões) na Scopus
    Effect of age at disease onset in the clinical profile of spondyloarthritis: a study of 1424 Brazilian patients
    (2012) SKARE, T. L.; LEITE, N.; BORTOLUZZO, A. B.; GONCALVES, C. R.; SILVA, J. A. B. da; XIMENES, A. C.; BERTOLO, M. B.; RIBEIRO, S. L. E.; KEISERMAN, M.; MENIN, R.; CARNEIRO, S.; AZEVEDO, V. F.; VIEIRA, W. P.; ALBUQUERQUE, E. N.; BIANCHI, W. A.; BONFIGLIOLI, R.; CAMPANHOLO, C.; CARVALHO, H. M. S.; COSTA, I. P.; DUARTE, A. P.; GAVI, M. B. O.; KOHEM, C. L.; LIMA, S. A. L.; MEIRELLES, E. S.; PEREIRA, I. A.; PINHEIRO, M. M.; POLITO, E.; RESENDE, G. G.; ROCHA, F. A. C.; SANTIAGO, M. B.; SAUMA, M. F. L. C.; SAMPAIO-BARROS, P. D.
    Objectives To analyse demographic and clinical variables in patients with disease onset before and after 40, 45 and 50 years in a large series of Brazilian SpA patients. Methods A common protocol of investigation was prospectively applied to 1424 SpA patients in 29 centres distributed through the main geographical regions in Brazil. The mean age at disease onset was 28.56 +/- 12.34 years, with 259 patients (18.2%) referring disease onset after 40 years, 15.1 (10.6%) after 45 years and 81 (5.8%) after 50 years. Clinical and demographic variables and disease indices (BASDAI, BASFI, BASRI, MASES, ASQoL) were investigated. Ankylosing spondylitis was the most frequent disease (66.3%), followed by psoriatic arthritis (18%), undifferentiated SpA (6.7%), reactive arthritis (5.5%), and enteropathic arthritis (3.5%). Results Comparing the groups according to age of disease onset, those patients with later onset presented statistical association with female gender, peripheral arthritis, dactylitis, nail involvement and psoriasis, as well as negative statistical association with inflammatory low hack pain, alternating buttock pain, radiographic sacroiliitis, hip involvement, positive familial history, HLA-B27 and uveitis. BASDAI, BASFI and quality of life, as well as physicians and patient's global assessment, were similar in all the groups. Radiographic indices showed worse results in the younger age groups. Conclusion There are two different clinical patterns in SpA defined by age at disease onset: one with predominance of axial symptoms in the group with disease onset <= 40 years and another favouring the peripheral manifestations in those with later disease onset.
  • conferenceObject
    EPIDEMIOLOGIC PROFILE OF JUVENILE SPONDYLOARTHRITIS COMPARED TO ADULT-ONSET SPONDYLOARTHRITIS IN A LARGE BRAZILIAN COHORT
    (2012) DUARTE, A. P.; MARQUES, C. D. L.; BORTOLUZZO, A. B.; GONCALVES, C. R.; SILVA, Braga J. A. da; XIMENES, A. C.; BERTOLO, M. B.; RIBEIRO, S. L.; KEISERMAN, M.; MENIN, R.; SKARE, T. L.; CARNEIRO, S.; AZEVEDO, V. F.; VIEIRA, W. P.; ALBUQUERQUE, E. N.; BIANCHI, W. A.; BONFIGLIOLI, R.; CAMPANHOLO, C.; CARVALHO, H. M. S.; COSTA, I. P.; KOHEM, C. L.; LEITE, N. H.; LIMA, S. A. L.; MEIRELLES, E. S.; PEREIRA, I. A.; PINHEIRO, M. M.; POLITO, E.; RESENDE, G. G.; ROCHA, F. A. C.; SANTIAGO, M. B.; SAUMA, M. F. L. C.; VALIM, V.; SAMPAIO-BARROS, P. D.
  • article 19 Citação(ões) na Scopus
    Recommendations for the management and treatment of psoriatic arthritis
    (2013) CARNEIRO, Sueli; AZEVEDO, Valderilio Feijo; BONFIGLIOLI, Rubens; RANZA, Roberto; GONCALVES, Celio Roberto; KEISERMAN, Mauro; MEIRELLES, Eduardo de Souza; PINHEIRO, Marcelo de Medeiros; XIMENES, Antonio Carlos; BERNARDO, Wanderley; SAMPAIO-BARROS, Percival Degrava
  • article 27 Citação(ões) na Scopus
    Chronic Spinal and Oral Morphine-Induced Neuroendocrine and Metabolic Changes in Noncancer Pain Patients
    (2015) VALVERDE-FILHO, Joao; CUNHA NETO, Malebranche Berardo Carneiro da; FONOFF, Erich Talamoni; MEIRELLES, Eduardo de Souza; TEIXEIRA, Manoel Jacobsen
    ObjectiveInteractions between opioid use and hormonal function are documented in the literature. However, it is unclear if therapeutic intrathecal opioid therapy can induce hormonal changes, compared to oral opioid therapy. MethodsThe authors studied hormone and metabolic changes in 22 women (18-60 years) and 38 men (18-45 years) who were referred to a pain center. The patients were allocated to different treatment groups (based on assistant physicians' decision), as follows: 20 patients received oral morphine (60-120 mg/day); 20 patients, spinal morphine (0.2-10 mg/day); and 20 patients, nonopioid analgesic treatment. ResultsAll three groups experienced substantial improvement in pain scores during the whole follow-up period. Significantly impaired libido, reduced potency, hot flashes, and menstrual cycle dysfunction occurred more often in both morphine groups than in the nonopioid group. Significantly low serum total testosterone levels were more prevalent in the spinal morphine group and the oral morphine group (58.3% and 70.0%, respectively) than in the control group (16.7%). Total cholesterol values above 200 mg/dL and higher ultrasensitive C-reactive protein levels were significantly more frequent in the morphine groups than in the controls. Total body bone mineral density was below normal in men receiving spinal morphine (P = 0.014). ConclusionsHypogonadotrophic hypogonadism was more prevalent in the morphine groups and was correlated with clinical findings. Significant bone mass loss occurred in morphine users, even without hormone dysfunction when compared to nonopioid treatment. Growth hormone, thyroid stimulating hormone, adrenocorticotrophic hormones, and cardiovascular risk parameters were less compromised in morphine users.
  • article 11 Citação(ões) na Scopus
    The Brazilian Society of Rheumatology guidelines for axial spondyloarthritis-2019
    (2020) RESENDE, Gustavo Gomes; MEIRELLES, Eduardo de Souza; MARQUES, Claudia Diniz Lopes; CHIEREGHIN, Adriano; LYRIO, Andre Marun; XIMENES, Antonio Carlos; SAAD, Carla Goncalves; GONCALVES, Celio Roberto; KOHEM, Charles Lubianca; SCHAINBERG, Claudia Goldenstein; CAMPANHOLO, Cristiano Barbosa; BUENO FILHO, Julio Silvio de Sousa; PIERUCCETTI, Lenise Brandao; KEISERMAN, Mauro Waldemar; YAZBEK, Michel Alexandre; PALOMINOS, Penelope Esther; GONCALVES, Rafaela Silva Guimaraes; LAGE, Ricardo da Cruz; ASSAD, Rodrigo Luppino; BONFIGLIOLI, Rubens; ANTI, Sonia Maria Alvarenga; CARNEIRO, Sueli; OLIVEIRA, Thauana Luiza; AZEVEDO, Valderilio Feijo; BIANCHI, Washington Alves; BERNARDO, Wanderley Marques; PINHEIRO, Marcelo de Medeiros; SAMPAIO-BARROS, Percival Degrava
    Spondyloarthritis is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. The classification axial spondyloarthritis is adopted when the spine and/or the sacroiliac joints are predominantly involved. This version of recommendations replaces the previous guidelines published in May 2013. A systematic literature review was performed, and two hundred thirty-seven studies were selected and used to formulate 29 recommendations answering 15 clinical questions, which were divided into four sections: diagnosis, non-pharmacological therapy, conventional drug therapy and biological therapy. For each recommendation the level of evidence supporting (highest available), the strength grade according to Oxford, and the degree of expert agreement (inter-rater reliability) is informed. These guidelines bring evidence-based information on clinical management of axial SpA patients, including, diagnosis, treatment, and prognosis.
  • article 59 Citação(ões) na Scopus
    Gender characterization in a large series of Brazilian patients with spondyloarthritis
    (2012) CARVALHO, Hellen M. S. de; BORTOLUZZO, Adriana B.; GONCALVES, Celio R.; SILVA, Jose Antonio Braga da; XIMENES, Antonio Carlos; BERTOLO, Manoel B.; RIBEIRO, Sandra L. E.; KEISERMAN, Mauro; MENIN, Rita; SKARE, Thelma L.; CARNEIRO, Sueli; AZEVEDO, Valderilio F.; VIEIRA, Walber P.; ALBUQUERQUE, Elisa N.; BIANCHI, Washington A.; BONFIGLIOLI, Rubens; CAMPANHOLO, Cristiano; COSTA, Izaias P.; DUARTE, Angela P.; GAVI, Maria Bernadete O.; KOHEM, Charles L.; LEITE, Nocy H.; LIMA, Sonia A. L.; MEIRELLES, Eduardo S.; PEREIRA, Ivanio A.; PINHEIRO, Marcelo M.; POLITO, Elizandra; RESENDE, Gustavo G.; ROCHA, Francisco Airton C.; SANTIAGO, Mittermayer B.; SAUMA, Maria de Fatima L. C.; SAMPAIO-BARROS, Percival D.
    An increasing number of women have been diagnosed with spondyloarthritis (SpA) in recent decades. While a few studies have analyzed gender as a prognostic factor of the disease, no studies have addressed this matter with a large number of patients in South America, which is a peculiar region due to its genetic heterogeneity. The aim of the present study was to analyze the influence of gender on disease patterns in a large cohort of Brazilian patients with SpA. A prospective study was carried out involving 1,505 patients [1,090 males (72.4%) and 415 females (27.6%)] classified as SpA according to the European Spondyloarthropaties Study Group criteria who attended at 29 reference centers for rheumatology in Brazil. Clinical and demographic variables were recorded and the following disease indices were administered: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Radiologic Index (BASRI), Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), and Ankylosing Spondylitis Quality of Life (ASQoL). Ankylosing spondylitis (AS) was the most frequent disease in the group (65.4%), followed by psoriatic arthritis (18.4%), undifferentiated SpA (6.7%), reactive arthritis (3.3%), arthritis associated to inflammatory bowel disease (3.2%), and juvenile SpA (2.9%). The male-to-female ratio was 2.6:1 for the whole group and 3.6:1 for AS. The females were older (p<0.001) and reported shorter disease duration (p=0.002) than the male patients. The female gender was positively associated to peripheral SpA (p<0.001), upper limb arthritis (p<0.001), dactylitis (p=0.011), psoriasis (p<0.001), nail involvement (p<0.001), and family history of SpA (p=0.045) and negatively associated to pure axial involvement (p< 0.001), lumbar inflammatory pain (p=0.042), radiographic sacroiliitis (p<0.001), and positive HLA-B27 (p=0.001). The number of painful (p<0.001) and swollen (p=0.006) joints was significantly higher in the female gender, who also achieved higher BASDAI (p<0.001), BASFI (p=0.073, trend), MASES (p=0.019), ASQoL (p=0.014), and patient's global assessment (p=0.003) scores, whereas the use of nonsteroidal anti-inflammatory drugs (p<0.001) and biological agents (p=0.003) was less frequent in the female gender. Moreover, BASRI values were significantly lower in females (p<0.001). The female gender comprised one third of SpA patients in this large cohort and exhibited more significant peripheral involvement and less functional disability, despite higher values in disease indices.
  • article 32 Citação(ões) na Scopus
    Effect of Enthesitis on 1505 Brazilian Patients with Spondyloarthritis
    (2013) CARNEIRO, Sueli; BORTOLUZZO, Adriana; GONCALVES, Celio; SILVA, Jose Antonio Braga da; XIMENES, Antonio C.; BERTOLO, Manoel; RIBEIRO, Sandra Lucia; KEISERMAN, Mauro; SKARE, Thelma; MENIN, Rita; AZEVEDO, Valderilio; VIEIRA, Walber; ALBUQUERQUE, Elisa; BIANCHI, Washington; BONFIGLIOLI, Rubens; CAMPANHOLO, Cristiano; CARVALHO, Hellen Mary de; COSTA, Izaias da; DUARTE, Angela; KOHEM, Charles; LEITE, Nocy; LIMA, Sonia A. L.; MEIRELLES, Eduardo S.; PEREIRA, Ivanio A.; PINHEIRO, Marcelo M.; POLITO, Elizandra; RESENDE, Gustavo G.; ROCHA, Francisco Airton C.; SANTIAGO, Mittermayer B.; SAUMA, Maria de Fatima L. C.; VALIM, Valeria; SAMPAIO-BARROS, Percival D.
    Objective. To analyze the clinical effect of enthesitis in a large Brazilian cohort of patients with spondyloarthritis (SpA). Methods. A common protocol of investigation was prospectively applied to 1505 patients with SpA in 29 centers in Brazil. Clinical and demographic variables and disease indexes were investigated. The Maastricht Ankylosing Spondylitis Enthesitis Score was used to investigate the enthesitis component. Ankylosing spondylitis was the most frequent disease in the group (65.4%). Others were psoriatic arthritis (18.4%), undifferentiated SpA (6.7%), reactive arthritis (3.3%), and enteropathic arthritis (3.2%). Results. At least 1 affected enthesis was observed in 54% of the patients with SpA, with a mean of 2.12 +/- 2.98 entheses affected. According to the clinical presentation, enthesitis was significantly more frequent in patients with axial + peripheral joint involvement compared to isolated axial or peripheral involvement (p < 0.001). There was a statistical association between the presence of enthesites and axial symptoms (buttock pain, cervical pain, and hip pain), and peripheral symptoms (lower limb arthritis, number of painful and swollen joints; p < 0.05). Patients with enthesitis also presented higher mean scores of Bath Ankylosing Spondylitis Functional Index (BASFI; p < 0.001), Bath Ankylosing Spondylitis Disease Activity Index (p < 0.001), and Ankylosing Spondylitis Quality of Life (ASQoL; p < 0.001). Multivariate logistic regression showed that BASFI (p < 0.0001; OR 74.839), ASQoL (p = 0.0001; OR 14.645), and Achilles tendonitis (p = 0.0059; OR 7.593) were associated with work incapacity. Conclusion. The clinical presence of enthesitis in this large cohort of patients with SpA was frequent and was associated with a significant increase in disease activity and decline in functional capacity and quality of life.
  • conferenceObject
    COST-EFFECTIVENESS ANALYSIS OF CERTOLIZUMAB PEGOL IN PATIENTS WITH RHEUMATHOID ARTHRITIS FROM A BRAZILIAN PRIVATE PERSPECTIVE
    (2012) PIHA, T.; MEIRELLES, E. D. S.; KURIKI, W.; MIRANDA, P. A.
    Objectives: Currently, anti-TNFα monoclonal antibodies are the mainstay of therapy in patients with active rheumatoid arthritis (RA) and inadequate response to methotrexate (MTX) alone. The purpose of this analysis is to evaluate the cost-effectiveness of certolizumab pegol (CZP) versus other anti-TNF (adalimumab[ADA], infliximab [INF] and etanercept [ETA]) as adjunctive therapy to MTX from the perspective of the Brazilian private health care system. Methods: Cost-effectiveness for 52 weeks of treatment was evaluated based on the ACR20 response rate at week 24 based on main published RCTs for each anti- TNF. An indirect comparison was performed using Glenny et al method1. Annual drug costs for each aTNF were calculated from their published ex-factory prices and their recommended dosing schedule in the Brazilian product information. For the calculation of the annual INF cost, the initial weight of the patient assumed for the model was assumed to be 65Kg, with no increment of the doses after 22 weeks. Results are presented in USD (June 11th, 2012 exchange rate) annual costs and incremental cost-effectiveness ratios (ICER's). A sensitivity analysis was made on price discount rate. Results: Annual costs were estimated in USD $12,619, USD $39,305, USD $24,267 and USD $35,617 for CZP, ADA, INF and ETA, respectively. Adjusted by indirect comparison of ACR20 response were 77% for CZP and 67%, 61% and 45% for ADA, INF and ETA, respectively. The cost effective ratio was USD $16,484 for CZP and USD $79,742, USD $59,326, USD $40,299 for ETA, ADA and INF respectively. The cost-effectiveness analysis demonstrated that CZP was a dominant strategy compared with ADA, INF and ETA. Conclusions: Certolizumab pegol (CZP) is a cost- saving anti-TNF option for treating RA from a Brazilian private health care perspective.