EDUARDO DE SOUZA MEIRELLES
Projetos de Pesquisa
Unidades Organizacionais
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
LIM/41 - Laboratório de Investigação Médica do Sistema Músculoesquelético, Hospital das Clínicas, Faculdade de Medicina
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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.- 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 JacobsenObjectiveInteractions 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.
- 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.
- 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.- Ethnic Influence in Clinical and Functional Measures of Brazilian Patients with Spondyloarthritis(2012) SKARE, Thelma L.; 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; 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.; 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.Objective. Spondyloarthritides (SpA) can present different disease spectra according to ethnic background. The Brazilian Registry of Spondyloarthritis (RBE) is a nationwide registry that comprises a large databank on clinical, functional, and treatment data on Brazilian patients with SpA. The aim of our study was to analyze the influence of ethnic background in SpA disease patterns in a large series of Brazilian patients. Methods. A common protocol of investigation was prospectively applied to 1318 SpA patients in 29 centers distributed through the main geographical regions in Brazil. The group comprised whites (65%), African Brazilians (31.3%), and people of mixed origins (3.7%). Clinical and demographic variables and various disease index scores were compiled. Ankylosing spondylitis (AS) was the most frequent disease in the group (65.1%); others were psoriatic arthritis (18.3%), undifferentiated SpA (6.8%), enteropathic arthritis (3.7%), and reactive arthritis (3.4%). Results. White patients were significantly associated with psoriasis (p = 0.002), positive HLA-B27 (p = 0.014), and use of corticosteroids (p < 0.0001). Hip involvement (p = 0.02), axial inflammatory pain (p = 0.04), and radiographic sacroiliitis (p = 0.025) were associated with African Brazilian descent. Sex distribution, family history, and presence of peripheral arthritis, uveitis, dactylitis, urethritis, and inflammatory bowel disease were similar in the 3 groups, as well as age at disease onset, time from first symptom until diagnosis, and use of anti-tumor necrosis factor-a agents (p > 0.05). Schober test and thoracic expansion were similar in the 3 groups, whereas African Brazilians had higher Maastricht Ankylasing Spondylitis Enthesitis Scores (p = 0.005) and decreased lateral lumbar flexion (p = 0.003), while whites had a higher occiput-to-wall distance (p = 0.02). African Brazilians reported a worse patient global assessment of disease (p = 0.011). Other index scores and prevalence of work incapacity were similar in the 3 groups, although African Brazilians had worse performance in the Ankylosing Spondylitis Quality of Life questionnaire (p < 0.001). Conclusion. Ethnic background is associated with distinct clinical aspects of SpA in Brazilian patients. African Brazilian patients with SpA have a poorer quality of life and report worse disease compared to whites.
- Evaluation of the association between osteoporosis and postural balance in postmenopausal women(2013) BRECH, Guilherme Carlos; PLAPLER, Perola Grinberg; MEIRELLES, Eduardo de Souza; MARCOLINO, Flora Maria D'Andrea; GREVE, Julia Maria D'AndreaThe incidence of osteoporosis has been increasing, as have fractures resulting from falls. Postural balance was evaluated in postmenopausal women with and without lumbar osteoporosis. One hundred and twenty-six postmenopausal women aged 55-65 years were evaluated and separated into two groups according to the bone mineral density values of their lumbar spine: the osteoporosis group and the control group, paired by age (P = 0.219) and physical activity (P = 0.611). There was no difference between the groups (P = 0.139) regarding falls reported in the previous 12 months. Functional mobility was evaluated through the Timed Up and Go Test. Postural balance was evaluated using a portable force platform in standard standing position, with eyes open and closed, for 60 s. Muscle strength was evaluated through an isokinetic dynamometer. This study shows that there is no difference in knee muscle strength and functional mobility (P = 0.121), postural balance with eyes open [mediolateral displacement (P = 0.286) and mean velocity of the center of pressure (COP) (P = 0.173)] and with eyes closed [mediolateral displacement (P = 0.163), and the mean velocity of displacement of the COP (P = 0.09)] in both groups. Subjects reporting falls had greater mediolateral displacement (P = 0.028) in both groups. Postmenopausal women aged between 55 and 65 years do not present changes in postural balance irrespective of lumbar osteoporosis. Greater COP mediolateral displacement is related to the occurrence of falls in postmenopausal women in the previous year.
- Assessment of fatigue in a large series of 1492 Brazilian patients with Spondyloarthritis(2014) BIANCHI, Washington A.; ELIAS, Fernanda R.; CARNEIRO, Sueli; BORTOLUZZO, Adriana B.; GONCALVES, Celio R.; SILVA, Jose Antonio Braga da; XIMENES, Antonio Carlos; BERTOLO, Manoel B.; RIBEIRO, Sandra L. E.; KEISERMAN, Mauro; SKARE, Thelma L.; MENIN, Rita; AZEVEDO, Valderilio F.; VIEIRA, Walber P.; ALBUQUERQUE, Elisa N.; 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, 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.Background. The aim of the present study was to analyze the score of fatigue in a large cohort of Brazilian patients with SpA, comparing different disease patterns and its association with demographic and disease-specific variables. Methods. A common protocol of investigation was prospectively applied to 1492 Brazilian patients classified as SpA according to the European Spondyloarthropathies Study Group (ESSG) criteria, attended at 29 reference centers. Clinical and demographic variables were recorded. Fatigue was evaluated using the first item of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) questionnaire. Results. The mean BASDAI fatigue score was 4.20 +/- 2.99. There was no significant difference in the fatigue score between the different SpA. Fatigue was higher in female patients (p < 0.001), with mixed (axial vertical bar peripheral) involvement (p < 0.001) and in those who did not practice exercises (p < 0.001). Higher scores of fatigue were significantly associated with inflammatory low back pain (p = 0.013), alternating buttock pain (p = 0.001), cervical pain (p = 0.001), and hip involvement (p = 0.005). Fatigue presented a moderate positive statistical correlation with Bath Ankylosing Spondylitis Functional Index (BASFI) (0.469; p < 0.001) and Ankylosing Spondylitis Quality of Life (0.462; p < 0.001). Conclusion. In this large series of Brazilian SpA patients, higher fatigue scores were associated with female gender, sedentary, worse functionality, and quality of life.
conferenceObject DISEASE PATTERNS OF PSORIATIC ARTHRITIS IN A LARGE SERIES OF BRAZILIAN PATIENTS WITH SPONDYLOARTHRITIS(2012) BONFIGLIOLI, R.; BONOLUZZO, 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. M. N.; BIANCHI, W. A.; CAMPANHOLO, C.; CARVALHO, H. M. S.; COSTA, I. P.; DUARTE, A. 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.; VALIN, V.; SAMPAIO-BARROS, P. D.