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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  • 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
  • article 4 Citação(ões) na Scopus
    Extra-articular manifestations of rheumatoid arthritis remain a major challenge: data from a large, multi-centric cohort
    (2023) BONFIGLIOLI, Karina Rossi; RIBEIRO, Ana Cristina de Medeiros; CARNIELETTO, Ana Paula; PEREIRA, Ivanio; DOMICIANO, Diogo Souza; SILVA, Henrique Carrico da; PUGLIESI, Alisson; PEREIRA, Leticia Rocha; GUIMARAES, Maria Fernanda Resende; GIORGI, Rina Dalva Neubarth; REIS, Ana Paula Monteiro Gomides; BRENOL, Claiton Viegas; LOUZADA-JUNIOR, Paulo; SAUMA, Maria de Fatima Lobato da Cunha; RADOMINSKI, Sebastiao Cezar; MOTA, Licia Maria Henrique da; CASTELAR-PINHEIRO, Geraldo da Rocha
    Introduction Although Rheumatoid Arthritis (RA) extra-articular manifestations (ExtRA) occurrence has been decreasing over time, they are still a major mortality risk factor for patients. Objective To determine the prevalence of ExtRA in a large cohort, and its association with demographic and clinical variables. Method Cross-sectional and observational study, based on a multi-centric database from a prospective cohort, in which 11 public rheumatology centres enrolled RA patients (1987 ARA or 2010 ACR-EULAR). Data collection began in 08-2015, using a single online electronic medical record. Continuous variables were compared using Mann-Whitney U-test, and Fisher's exact test or chi-square test, as appropriate, were used for categorical variables. The level of significance was set at 5% (p < 0.05). Results 1115 patients were included: 89% women, age [mean +/- SD] 58.2 +/- 11.5 years, disease duration 14.5 +/- 12.2 years, positive Rheumatoid Factor (RF, n = 1108) in 77%, positive anti-cyclic citrullinated peptide (ACPA, n = 477) in 78%. Regarding ExtRA, 334 occurrences were registered in 261 patients, resulting in an overall prevalence of 23.4% in the cohort. The comparison among ExtRA and Non-ExtRA groups shows significant higher age (p < 0.001), disease duration (p < 0.001), RF high titers (p = 0.018), Clinical Disease Activity index (CDAI) (p < 0.001), Disease Activity Index 28 (DAS 28) (p < 0.001), and Health Assessment Questionnaire (HAQ) (p < 0.001) in ExtRA group. Treatment with Azathioprine (p = 0.002), Etanercept (p = 0.049) Glucocorticoids (GC) ('p = 0.002), and non-steroidal anti-inflammatory drugs (NSAIDs) (p < 0.001) were more frequent in ExtRA group. Conclusions ExtRA manifestations still show an expressive occurrence that should not be underestimated. Our findings reinforce that long-term seropositive disease, associated with significant disability and persistent inflammatory activity are the key factors related to ExtRA development.
  • article 1 Citação(ões) na Scopus
    Heterogeneity in rheumatoid arthritis-associated interstitial lung disease: time for splitting?
    (2022) KAWANO-DOURADO, Leticia; BONFIGLIOLI, Karina
  • article 0 Citação(ões) na Scopus
    A single session of aerobic exercise reduces systolic blood pressure at rest and in response to stress in women with rheumatoid arthritis and hypertension
    (2024) LUNA, Tatiane Almeida de; REZENDE, Diego Augusto Nunes; BRITO, Leandro Campos de; FECCHIO, Rafael Yokoyama; LIMA, Fernanda Rodrigues; PINTO, Ana Lucia de Sa; RIBEIRO, Ana Cristina de Medeiros; BONFIGLIOLI, Karina Rossi; GUALANO, Bruno; ROSCHEL, Hamilton; PECANHA, Tiago
    Rheumatoid arthritis (RA) is an autoimmune inflammatory disease characterized by increased risk of cardiovascular disease and hypertension (HT). A single session of aerobic exercise may reduce blood pressure (BP) in different clinical groups; however, little is known about the acute effects of exercise on BP in RA patients. This is a randomized controlled crossover study that assessed the effects of a single session of aerobic exercise on resting BP, on BP responses to stressful stimuli, and on 24-h BP in women with RA and HT. Twenty women with RA and HT (53 +/- 10 years) undertook sessions of 30-min treadmill exercise (50% VO2max) or control (no exercise) in a crossover fashion. Before and after the sessions, BP was measured at rest, and in response to the Stroop-Color Word Test (SCWT), the Cold Pressor Test (CPT), and an isometric handgrip test. After the sessions, participants were also fitted with an ambulatory BP monitor for the assessment of 24-h BP. A single session of exercise reduced resting systolic BP (SBP) (-5 +/- 9 mmHg; p < 0.05), and reduced SBP response to the SCWT (-7 +/- 14 mmHg; p < 0.05), and to the CPT (-5 +/- 11 mmHg; p < 0.05). Exercise did not reduce resting diastolic BP (DBP), BP responses to the isometric handgrip test or 24-h BP. In conclusion, a single session of aerobic exercise reduced SBP at rest and in response to stressful stimuli in hypertensive women with RA. These results support the use of exercise as a strategy for controlling HT and, hence, reducing cardiovascular risk in women with RA.
  • conferenceObject
    Risk Factors for Osteoporotic Fracture in Women with Established Long-Term Rheumatoid Arthritis
    (2022) SILVA, Felipe Freire Da; MACHADO, Gisela; MEDEIROS, Ana; BONFIGLIOLI, Karina; SHIMABUCO, Andrea; TAKAYAMA, Liliam; PEREIRA, Rosa; DOMICIANO, Diogo
  • article 9 Citação(ões) na Scopus
    Reliability assessment of the definition of ultrasound enthesitis in SpA: results of a large, multicentre, international, web-based study
    (2022) MATTEO, Andrea Di; CIPOLLETTA, Edoardo; CASTANITI, Giulia Maria Destro; SMERILLI, Gianluca; AIROLDI, Carla; AYDIN, Sibel Zehra; BECCIOLINI, Andrea; BONFIGLIOLI, Karina; BRUNS, Alessandra; CARRARA, Greta; CAZENAVE, Tomas; CIAPETTI, Alessandro; COSATTI, Micaela Ana; AGUSTIN, Juan Jose de; CARLO, Marco Di; DONATO, Eleonora Di; GESO, Luca Di; DURAN, Emine; ELLIOTT, Ashley; ESTRACH, Cristina; FARISOGULLARI, Bayram; FIORENZA, Alessia; FODOR, Daniela; GABBA, Alessandra; HERNANDEZ-DIAZ, Cristina; HUANG, Feng; HURNAKOVA, Jana; LI, Ling; JESUS, Diogo; KARADAG, Omer; MARTIRE, Maria Victoria; MASSAROTTI, Marco; MICHELENA, Xabier; MUSCA, Alice Andreea; NAIR, Jagdish; OKANO, Tadashi; PAPALOPOULOS, Ioannis; ROSEMFFET, Marcos; ROVISCO, Joao; ROZZA, Davide; SALAFFI, Fausto; SATULU, Iulia; SCIOSCIA, Crescenzio; SCIRE, Carlo Alberto; SUN, Fei; TAMAS, Maria-Magdalena; TANIMURA, Shun; VENTURA-RIOS, Lucio; VOULGARI, Paraksevi V.; VREJU, Florentin Ananu; VUKATANA, Gentiana; WONG, Ernest; YANG, Jinshui; HERETER, Johana Zacariaz; ZANETTI, Anna; GRASSI, Walter; FILIPPUCCI, Emilio
    Objectives To investigate the reliability of the OMERACT US Task Force definition of US enthesitis in SpA. Methods In this web exercise, based on the evaluation of 101 images and 39 clips of the main entheses of the lower limbs, the elementary components included in the OMERACT definition of US enthesitis in SpA (hypoechoic areas, entheseal thickening, power Doppler signal at the enthesis, enthesophytes/calcifications, bone erosions) were assessed by 47 rheumatologists from 37 rheumatology centres in 15 countries. Inter- and intra-observer reliability of the US components of enthesitis was calculated using Light's kappa, Cohen's kappa, Prevalence And Bias Adjusted Kappa (PABAK) and their 95% CIs. Results Bone erosions and power Doppler signal at the enthesis showed the highest overall inter-reliability [Light's kappa: 0.77 (0.76-0.78), 0.72 (0.71-0.73), respectively; PABAK: 0.86 (0.86-0.87), 0.73 (0.73-0.74), respectively], followed by enthesophytes/calcifications [Light's kappa: 0.65 (0.64-0.65), PABAK: 0.67 (0.67-0.68)]. This was moderate for entheseal thickening [Light's kappa: 0.41 (0.41-0.42), PABAK: 0.41 (0.40-0.42)], and fair for hypoechoic areas [Light's kappa: 0.37 (0.36-0.38); PABAK: 0.37 (0.37-0.38)]. A similar trend was observed in the intra-reliability exercise, although this was characterized by an overall higher degree of reliability for all US elementary components compared with the inter-observer evaluation. Conclusions The results of this multicentre, international, web-based study show a good reliability of the OMERACT US definition of bone erosions, power Doppler signal at the enthesis and enthesophytes/calcifications. The low reliability of entheseal thickening and hypoechoic areas raises questions about the opportunity to revise the definition of these two major components for the US diagnosis of enthesitis.
  • article 2 Citação(ões) na Scopus
    Reliability assessment of ultrasound muscle echogenicity in patients with rheumatic diseases: Results of a multicenter international web-based study
    (2023) MATTEO, Andrea Di; MOSCIONI, Erica; LOMMANO, Maria Giovanna; CIPOLLETTA, Edoardo; SMERILLI, Gianluca; FARAH, Sonia; AIROLDI, Carla; AYDIN, Sibel Zehra; BECCIOLINI, Andrea; 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; MIRZA, Riccardo Mashadi; MASSAROTTI, Marco; MUSCA, Alice Andreea; NAIR, Jagdish; OKANO, Tadashi; PAPALOPOULOS, Ioannis; ROSA, Javier; 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, Paraskevi V.; VREJU, Florentin Ananu; VUKATANA, Gentiana; HERETER, Johana Zacariaz; ZANETTI, Anna; GRASSI, Walter; FILIPPUCCI, Emilio
    ObjectivesTo investigate the inter/intra-reliability of ultrasound (US) muscle echogenicity in patients with rheumatic diseases. MethodsForty-two rheumatologists and 2 radiologists from 13 countries were asked to assess US muscle echogenicity of quadriceps muscle in 80 static images and 20 clips from 64 patients with different rheumatic diseases and 8 healthy subjects. Two visual scales were evaluated, a visual semi-quantitative scale (0-3) and a continuous quantitative measurement (""VAS echogenicity,"" 0-100). The same assessment was repeated to calculate intra-observer reliability. US muscle echogenicity was also calculated by an independent research assistant using a software for the analysis of scientific images (ImageJ). Inter and intra reliabilities were assessed by means of prevalence-adjusted bias-adjusted Kappa (PABAK), intraclass correlation coefficient (ICC) and correlations through Kendall's Tau and Pearson's Rho coefficients. ResultsThe semi-quantitative scale showed a moderate inter-reliability [PABAK = 0.58 (0.57-0.59)] and a substantial intra-reliability [PABAK = 0.71 (0.68-0.73)]. The lowest inter and intra-reliability results were obtained for the intermediate grades (i.e., grade 1 and 2) of the semi-quantitative scale. ""VAS echogenicity"" showed a high reliability both in the inter-observer [ICC = 0.80 (0.75-0.85)] and intra-observer [ICC = 0.88 (0.88-0.89)] evaluations. A substantial association was found between the participants assessment of the semi-quantitative scale and ""VAS echogenicity"" [ICC = 0.52 (0.50-0.54)]. The correlation between these two visual scales and ImageJ analysis was high (tau = 0.76 and rho = 0.89, respectively). ConclusionThe results of this large, multicenter study highlighted the overall good inter and intra-reliability of the US assessment of muscle echogenicity in patients with different rheumatic diseases.
  • article 0 Citação(ões) na Scopus
    Decreasing delays in the diagnosis and treatment of rheumatoid arthritis in Brazil: a nationwide multicenter observational study
    (2023) ALBUQUERQUE, Cleandro Pires de; REIS, Ana Paula Monteiro Gomides; SANTOS, Ana Beatriz Vargas; BERTOLO, Manoel Barros; LOUZADA JUNIOR, Paulo; GIORGI, Rina Dalva Neubarth; RADOMINSKI, Sebastiao Cezar; GUIMARAES, Maria Fernanda B. Resende; BONFIGLIOLI, Karina Rossi; SAUMA, Maria de Fatima L. da Cunha; PEREIRA, Ivanio Alves; BRENOL, Claiton Viegas; MOTA, Licia Maria Henrique da; SANTOS-NETO, Leopoldo; PINHEIRO, Geraldo R. Castelar
    BackgroundManagement delays imply worse outcomes in rheumatoid arthritis (RA) and, therefore, should be minimized. We evaluated changes in diagnostic and treatment delays regarding RA in the last decades in Brazil.MethodsAdults fulfilling the ACR/EULAR (2010) criteria for RA were assessed. Delays in diagnosis and treatment, and the frequencies of early management initiation within thresholds (windows of opportunity) of 3, 6, and 12 months from symptoms onset were evaluated. The Mann-Kendall trend test, chi-squared tests with Cramer's V effect sizes and analysis of variance were conducted.ResultsWe included 1116 patients: 89.4% female, 56.8% white, mean (SD) age 57.1 (11.5) years. A downward trend was found in diagnostic (tau = - 0.677, p < 0.001) and treatment (tau = - 0.695, p < 0.001) delays from 1990 to 2015. The frequency of early management increased throughout the period, with ascending effect sizes across the 3-, 6-, and 12-month windows (V = 0.120, 0.200 and 0.261, respectively). Despite all improvements, even in recent years (2011-2015) the diagnostic and treatment delays still remained unacceptably high [median (IQR): 8 (4-12) and 11 (5-17) months, respectively], with only 17.2% of the patients treated within the shortest, 3-month window.ConclusionThe delays in diagnosis and treatment of RA decreased during the last decades in Brazil. Improvements (effect sizes) were greater at eliminating extreme delays (>= 12 months) than in attaining really short management windows (<= 3 months). Very early treatment was still an unrealistic goal for most patients with RA.
  • article 0 Citação(ões) na Scopus
    Do it fast! Early access to specialized care improved long-term outcomes in rheumatoid arthritis: data from the REAL multicenter observational study
    (2023) ALBUQUERQUE, Cleandro Pires; REIS, Ana Paula Monteiro Gomides; SANTOS, Ana Beatriz Vargas; BERTOLO, Manoel Barros; LOUZADA JUNIOR, Paulo; GIORGI, Rina Dalva Neubarth; RADOMINSKI, Sebastiao Cezar; GUIMARAES, Maria Fernanda B. Resende; BONFIGLIOLI, Karina Rossi; SAUMA, Maria de Fatima L. Cunha; PEREIRA, Ivanio Alves; BRENOL, Claiton Viegas; MOTA, Licia Maria Henrique; SANTOS-NETO, Leopoldo; PINHEIRO, Geraldo Rocha Castelar
    BackgroundEarly rheumatoid arthritis (RA) offers an opportunity for better treatment outcomes. In real-life settings, grasping this opportunity might depend on access to specialized care. We evaluated the effects of early versus late assessment by the rheumatologist on the diagnosis, treatment initiation and long-term outcomes of RA under real-life conditions.MethodsAdults meeting the ACR/EULAR (2010) or ARA (1987) criteria for RA were included. Structured interviews were conducted. The specialized assessment was deemed ""early"" when the rheumatologist was the first or second physician consulted after symptoms onset, and ""late"" when performed afterwards. Delays in RA diagnosis and treatment were inquired. Disease activity (DAS28-CRP) and physical function (HAQ-DI) were evaluated. Student's t, Mann-Whitney U, chi-squared and correlation tests, and multiple linear regression were performed. For sensitivity analysis, a propensity score-matched subsample of early- vs. late-assessed participants was derived based on logistic regression. The study received ethical approval; all participants signed informed consent.ResultsWe included 1057 participants (89.4% female, 56.5% white); mean (SD) age: 56.9 (11.5) years; disease duration: 173.1 (114.5) months. Median (IQR) delays from symptoms onset to both RA diagnosis and initial treatment coincided: 12 (6-36) months, with no significant delay between diagnosis and treatment. Most participants (64.6%) first sought a general practitioner. Notwithstanding, 80.7% had the diagnosis established only by the rheumatologist. Only a minority (28.7%) attained early RA treatment (<= 6 months of symptoms). Diagnostic and treatment delays were strongly correlated (rho 0.816; p < 0.001). The chances of missing early treatment more than doubled when the assessment by the rheumatologist was belated (OR 2.77; 95% CI: 1.93, 3.97). After long disease duration, late-assessed participants still presented lower chances of remission/low disease activity (OR 0.74; 95% CI: 0.55, 0.99), while the early-assessed ones showed better DAS28-CRP and HAQ-DI scores (difference in means [95% CI]: -0.25 [-0.46, -0.04] and - 0.196 [-0.306, -0.087] respectively). The results in the propensity-score matched subsample confirmed those observed in the original (whole) sample.ConclusionsEarly diagnosis and treatment initiation in patients with RA was critically dependent on early access to the rheumatologist; late specialized assessment was associated with worse long-term clinical outcomes.