KARINA ROSSI BONFIGLIOLI

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

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  • article 126 Citação(ões) na Scopus
    Methotrexate and rheumatoid arthritis associated interstitial, Lung disease
    (2021) JUGE, Pierre-Antoine; LEE, Joyce S.; LAU, Jessica; KAWANO-DOURADO, Leticia; SERRANO, Jorge Rojas; SEBASTIANI, Marco; KODURI, Gouri; MATTESON, Eric; BONFIGLIOLI, Karina; SAWAMURA, Marcio; KAIRALLA, Ronaldo; CAVAGNA, Lorenzo; CASSIONE, Emanuele Bozzalla; MANFREDI, Andreina; MEJIA, Mayra; RODRIGUEZ-HENRIQUEZ, Pedro; GONZALEZ-PEREZ, Montserrat I.; FALFAN-VALENCIA, Ramces; BUENDIA-ROLDAN, Ivette; PEREZ-RUBIO, Gloria; EBSTEIN, Esther; GAZAL, Steven; BORIE, Raphael; OTTAVIANI, Sebastien; KANNENGIESSER, Caroline; WALLAERT, Benoit; UZUNHAN, Yurdagul; NUNES, Hilario; VALEYRE, Dominique; SAIDENBERG-KERMANAC, Nathalie; BOISSIER, Marie-Christophe; WEMEAU-STERVINOU, Lidwine; FLIPO, Rene-Marc; MARCHAND-ADAM, Sylvain; RICHETTE, Pascal; ALLANORE, Yannick; DROMER, Claire; TRUCHETET, Marie-Elise; RICHEZ, Christophe; SCHAEVERBEKE, Thierry; LIOTE, Huguette; THABUT, Gabriel; DEANE, Kevin D.; SOLOMON, Joshua J.; DOYLE, Tracy; RYU, Jay H.; ROSAS, Ivan; HOLERS, V. Michael; BOILEAU, Catherine; DEBRAY, Marie-Pierre; PORCHER, Raphael; SCHWARTZ, David A.; VASSALLO, Robert; CRESTANI, Bruno; DIEUDE, Philippe
    Question addressed by the study: Methotrexate (MTX) is a key anchor drug for rheumatoid arthritis (RA) management. Fibrotic interstitial lung disease (ILD) is a common complication of RA. Whether MTX exposure increases the risk of ILD in patients with RA is disputed. We aimed to evaluate the association of prior MTX use with development of RA-ILD. Methods: Through a case-control study design with discovery and international replication samples, we examined the association of MTX exposure with ILD in 410 patients with chronic fibrotic ILD associated with RA (RA-ILD) and 673 patients with RA without ILD. Estimates were pooled over the different samples using meta-analysis techniques. Results: Analysis of the discovery sample revealed an inverse relationship between MTX exposure and RA-ILD (adjusted OR 0.46, 95% CI 0.24 0.90; p=0.022), which was confirmed in the replication samples (pooled adjusted OR 0.39, 95% CI 0.19 -0.79; p=0.009). The combined estimate using both the derivation and validation samples revealed an adjusted OR of 0.43 (95% CI 0.26 0.69; p=0.0006). MTX ever-users were less frequent among patients with RA-ILD compared to those without II,D, irrespective of chest high-resolution computed tomography pattern. In patients with RA-ILD, ILD detection was significantly delayed in MTX ever-users compared to never-users (11.4 +/- 10.4 years and 4.0 +/- 7.4 years, respectively; p<0.001). Answer to the question: Our results suggest that MTX use is not associated with an increased risk of RA-ILD in patients with RA, and that ILD was detected later in MTX-treated patients.
  • article 3 Citação(ões) na Scopus
    Rheumatoid artrhitis treatment in Brazil: data from a large real-life multicenter study
    (2020) GOMIDES, Ana Paula Monteiro; ALBUQUERQUE, Cleandro Pires de; SANTOS, Ana Beatriz Vargas; BERTOLO, Manoel Barros; JUNIOR, Paulo Louzada; GIORGI, Rina Dalva Neubarth; RADOMINSKI, Sebastiao Cezar; GUIMARAES, Maria Fernanda B.; BONFIGLIOLI, Karina Rossi; SAUMA, Maria de Fatima Lobato da Cunha; PEREIRA, Ivanio Alves; BRENOL, Claiton Viegas; MOTA, Licia Maria Henrique da; PINHEIRO, Geraldo da Rocha Castelar
    Background Last decades witnessed great technological advances in rheumatoid arthritis (RA) management, but their implementation in clinical practice might prove difficult. Despite the efficacy demonstrated in controlled trials this information needs to be confirmed by real life data. This study assessed real-life treatment among RA patients. Methods REAL study included Brazilian RA patients from eleven centers. Interview and medical records were performed. Continuous variables were compared using Student's t or Mann-Whitney and categorical variables were assessed with chi-square or Fisher's exact tests. Results 1115 patients were included, women 89.5%. Median age 56.6 years, disease duration 152.5 months; 78.7% were rheumatoid fator positive; 55.2% had erosive disease; DAS28 (disease activity index-28 joints) = 3.5, HAQ (health assessment questionnaire) =0.875. The median duration of symptoms until the start of first DMARD was 12 months. A total of 529 (47.2%) patients used corticosteroids; 1022 (90.8%) were on conventional synthetic (cs) DMARDs and 406 (36.1%) on biological (b) DMARDs. Methotrexate (MTX) was the most frequent csDMARD: 748 (66.5%) patients, followed by leflunomide (LFN), used by 381 (33.9%) of patients. MTX was associated to LFN in 142 (12.6%) patients. Only five (0.4%) patients used triple therapy (MTX + hydroxychloroquine + sulfasalazine) or sulfasalazine in monotherapy. Conclusions Despite advances in therapeutic resources, roughly half RA patients failed achieve T2T goals and 55.2% developed erosive disease. The frequent use of corticosteroids and delay in initiating DMARDs were demonstrated. Issues concerning timely access to medical care are crucial for effective management.
  • conferenceObject
    Ultrasound Is Reliable in the Assessment of Muscle Echogenicity in Patients with Rheumatic Diseases: Results of a Multicenter International Web-based Study
    (2022) MATTEO, Andrea Di; MOSCIONI, Erica; LOMMANO, Maria Giovanna; CIPOLLETTA, Edoardo; SMERILLI, Gianluca; FARAH, Sonia; AIROLDI, Carla; AYDIN, Sibel; ANDREA, Becciolini; BONFIGLIOLI, Karina; CAROTTI, Marina; CARRARA, Greta; CAZENAVE, Tomas; CORRADINI, Davide; COSATTI, Micaela Ana; AGUSTIN, Juan Jose de; CASTANITI, Giulia Maria Destro; CARLO, Marco Di; DONATO, Eleonora Di; GESO, Luca Di; ELLIOTT, Ashley; FODOR, Daniela; FRANCIOSO, Francesca; GABBA, Alessandra; HERNANDEZ-DIAZ, Cristina; HORVATH, Rudolf; HURNAKOVA, Jana; JESUS, Diogo; MARIN, Josefina; MARTIRE, Maria Victoria; MASHADI-MIRZA, Riccardo; MASSAROTTI, Marco; MUSCA, Alice Andreea; NAIR, Jagdish; OKANO, Tadashi; PAPALOPOULOS, Ioannis; ROSA, Javier Eduardo; ROSEMFFET, Marcos; ROVISCO, Joao; ROZZA, Davide; SALAFFI, Fausto; SCIOSCIA, Crescenzio; SCIRE, Carlo Alberto; TAMAS, Maria-Magdalena; TANIMURA, Shun; VENTURA-RIOS, Lucio; VILLOTA-ERASO, Catalina; VILLOTA, Orlando; VOULGARI, Paraksevi V.; VREJU, Florentin Ananu; VUKATANA, Gentiana; HERETER, Johana Zacariaz; ZANETTI, Anna; GRASSI, Walter; FILIPPUCCI, Emilio
  • conferenceObject
    Latent Tuberculosis Screening and Treatment In Ankylosing Spondylitis Patients Eligible For Anti-TNF Therapy In Endemic Area
    (2013) MIOSSI, Renata; BONFIGLIOLI, Karina Rossi; SAAD, Carla G. S.; RIBEIRO, Ana Cristina; MORAES, Julio C. B.; BONFA, Eloisa
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    BONE EROSIONS IN RHEUMATOID ARTHRITIS: ULTRASOUND FINDINGS IN THE EARLY STAGE OF THE DISEASE
    (2012) TAMAS, M. -M.; FILIPPUCCI, E.; BECCIOLINI, A.; GUTIERREZ, M.; GESO, L. Di; BONFIGLIOLI, K.; VOULGARI, P. V.; SALAFFI, F.; GRASSI, W.
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    Regular Measure of Disease Activity During the Routine Care of Rheumatoid Arthritis Patients Involves Some Extra Work but Positive Results
    (2012) GUEDES, Lissiane K. N.; RIBEIRO, Ana Cristina Medeiros; BONFIGLIOLI, Karina Rossi; DOMICIANO, Diogo; VIZIOLI, Carolina Reither; CUNHA, Gilmara Franco da; ABREU, Andressa Silva; MELLO, Filipi M.; FOELKEL, Ana Luiza de Aguiar; GONCALVES, Celio R.; LAURINDO, Ieda
    Background/Purpose: According to treat to target recommendations the use of validated composite measures of disease activity, which include joint assessments, is needed in routine clinical practice to guide treatment decisions with the final objective of reaching remission or low disease activity in patients with RA.Objective: to study the outcome of adding avalidated composite measure of disease activity (DAS28) to routine clinical visits. Methods: Since 2007 all RA patients (ACR-1987 criteria) in regular follow-up at the Rheumatology Service of a tertiary center change to electronic files with a DAS28-ESR calculator and this measure became mandatory in the routine care visits. Inclusion criteria: patients in regular follow-up for at least 2 years before 2007and no use of biologic agents during the study period (January 2007-December 2011). All patients could receive, free of charge, traditional DMARDs (chloroquine, methotrexate, sulfasalazine, leflunomide and azathioprine), corticosteroids (including intra-articular injections), analgesic and antiinflamatory medications as needed and according to a pre-established protocol. The first DAS28 recorded in the electronic files was compared to the last one recorded in 2011, after 4 years of regular measure of disease activity guiding therapeutic decisions (RA-study group). ERA patients (less than one year of symptoms at the beginning of treatment) submitted to a therapeutic strategy of tight control and DAS28 based clinical decisions were also evaluated. Results: a total of 304 patients was included, 217 consisting our study group(RA-SG) (86% female, mean age 63±11yrs, mean disease duration 22±10yrs) and 87 ERA patients (83% female, mean age 53±12yrs, mean disease duration 6.7±1.6yrs). ERA patients were significantly younger and with shorter disease duration. DAS28 values and different levels of disease activity are depicted below: RA-SG n217 ERA n87 2007 2011 2007 2011 DAS28 mean (SD) 3.9* (1.4) 3.3* (1.3) 3.7** (1.7) 2.9** (1.4)% DAS28 < 2.6 17* 34* 29** 45**% low disease activity 18 16 12** 24**% moderate disease activity 47 39 30** 9**% high disease activity 18 11 24 16*,** p0.05 Conclusion: regularly applying validate composite indexes such as DAS 28 leads to better control of disease activity, mainly an increased percentage of patients in DAS28 remission.
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    Pandemic Influenza Immunization in Primary Antiphospholipid Syndrome (PAPS): A Trigger to Autoantibody Production?
    (2012) MEDEIROS, Danielle M.; BUENO, Cleonice; RIBEIRO, Ana Cristina M.; CALICH, Ana L. G.; BONFIGLIOLI, Karina Rossi; VIANA, Vilma S.; CARVALHO, Jozelio F.; SILVA, Clovis Artur; BONFA, Eloisa
    Background/Purpose: There are scarce data suggesting that pan-demic influenza vaccination may induce antiphospholipid (APL) autoan- tibodies in inflammatory rheumatic diseases, particularly in systemic lupus erythematosus patients. However, there is no study evaluating the APL autoantibodies induction in primary antiphospholipid syndrome (PAPS) patients. The objective was to perform short and long-term evaluations of a large panel of APL autoantibodies following pandemic influenza A/H1N1 non-adjuvant vaccine in PAPS patients and healthy controls. Lupus specific antibodies were also investigated in these patients. Methods: Forty-five PAPS patients (Sapporo criteria) and 33 healthy controls were vaccinated with monovalent, inactivated H1N1 vaccine (Butantan Institute/Sanofi Pasteur, São Paulo, Brazil). They were prospec-tively assessed at pre-vaccination, 3 weeks and 6 months after vaccination. APL autoantibodies were determined by an enzyme-linked immunosor-bent assay (ELISA) and included: anti-cardiolipin (aCL) IgG/IgM and anti-β2GPI IgG/IgM antibodies (Inova Diagnostics, USA); anti-annexin V IgG/IgM, anti-phosphatidyl serine IgG/IgM and anti-prothrombin IgG/IgM (Orgentec Diagnostica, Germany). Anti-Sm was determined by ELISA (Inova Diagnostics, USA) and anti-dsDNA by indirect immun-fluorescence. Arterial and venous thromboses were also clinically assessed. The statistical analyses were carried out with qui square test, McNemar s test and one-way repeated measures analysis of variance (ANOVA). Results: Pre-vaccination frequency of at least one APL antibody was significantly higher in PAPS patients compared to controls (58% vs. 21%, p=0.003). The overall frequencies of APL antibody at pre-vaccination, 3 weeks and 6 months after immunization remained unchanged in patients (p=0.89) and controls (p=0.83). Further analysis of each evaluated antibody in PAPS revealed that their percentages at pre-vaccination and after 3 weeks and 6 months were also comparable (p>0.05): aCL IgG (42%, 38% and 42%), aCL IgM (22%, 20% and 24%), anti-β2GPI IgG (22%, 22% and 20%), anti-β2GPI IgM (15%, 15% and 18%), anti- annexin V IgG (4.5%, 4.5% and 2.5%), anti-annexin V IgM (uniformly negative), anti-phosphatidyl serine IgG (38%, 35% and 38%), anti- phosphatidyl serine IgM (15%, 13% and 13%), anti-prothrombin IgG (20%, 15% and 18%) and anti-prothrombin IgM (2.5%, 2.5% and 2.5%). The same pattern was observed for the control group (p>0.05). At 3 weeks, 2 PAPS patients developed a new but transient APL anti-body (moderate titer aCL IgG and IgM) whereas at 6 months, new APL antibodies were observed in 6 PAPS patients: 3 moderate titer aCL IgM, 1 moderate anti-β2GPI IgM, 1 low anti-phosphatidyl serine IgG and 1 low anti-prothrombin IgG. Fluctuations of antibody levels were not detected for any evaluated antibody (p>0.05). Of note, anti-Sm and anti-dsDNA autoantibodies were consistently negative during all evaluations. No new arterial or venous thrombosis events occurred during the study period. Conclusion: This was the first study to demonstrate that pandemic non-adjuvant influenza A/H1N1 in PAPS patients does not trigger a change in APL antibody profile or induce lupus specific autoantibodies.
  • bookPart
    Fibromialgia e síndrome miofascial
    (2015) BONFIGLIOLI, Karina R.
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    Bone Erosions and Osteophytes in Premenopausal Women with Long-standing Rheumatoid Arthritis: Association with Systemic Bone Involvement Using HR-pQCT
    (2021) PEREZ, Mariana; FIGUEIREDO, Camille; SALES, Lucas; MEDEIROS-RIBEIRO, Ana; TAKAYAMA, Liliam; DOMICIANO, Diogo; BONFIGLIOLI, Karina; CAPARBO, Valeria; PEREIRA, Rosa