KARINA ROSSI BONFIGLIOLI
Projetos de Pesquisa
Unidades Organizacionais
P ICHC, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina
8 resultados
Resultados de Busca
Agora exibindo 1 - 8 de 8
- 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, PhilippeQuestion 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.
- 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 CastelarBackground 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.
- 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 RochaIntroduction 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.
- Real-life data of survival and reasons for discontinuation of biological disease-modifying drugs 'in' rheumatoid arthritis(2021) 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. Resende; 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 CastelarBackgroundRheumatoid arthritis is a chronic, autoimmune disease in which treatment has evolved with a variety of therapeutic classes. Biological disease-modifying antirheumatic drugs have improved therapy; however, the continued long-term use of these drugs with sustained safety and efficacy remains a challenge.ObjectiveThe objective of this study was to analyze time of use and reasons for discontinuation of biological disease-modifying antirheumatic drugs in patients with rheumatoid arthritis.SettingIt is as part of REAL (Rheumatoid Arthritis in Real Life), a multicenter project that evaluated Brazilian patients with rheumatoid arthritis in a real-life setting. Eleven referral centers for the treatment in the public network participated in the study.MethodsWe conducted a cross-sectional analysis of data collected in the REAL study from August to October 2015 study. The patients were submitted to clinical evaluation and analysis of medical records.Results1125 patients were included (89.5% women; median age: 56.6 years; and disease time: 12.8 years). A total of 406 (36.09%) participants were on a biological disease-modifying antirheumatic drugs. Infliximab was the drug with the longest time of use (12 years). Most (64.4%) drug suspension episodes were due to inefficacy. Adalimumab and certolizumab had a greater number of suspensions due to primary inefficacy, while discontinuations for abatacept were due more to secondary inefficacy. Infliximab had fewer suspensions due to primary inefficacy and golimumab had fewer episodes of secondary inefficacy. Regarding side effects, infliximab was suspended a greater number of times because of clinical and laboratory side effects. Abatacept and adalimumab had fewer suspensions due to clinical side effects, and certolizumab, rituximab and tocilizumab had fewer laboratory adverse effects.ConclusionAmong the biological disease-modifying antirheumatic drugs being used for long periods, infliximab had greater time of use. Most drug suspensions (64%) were due to primary or secondary inefficacy. Number of discontinuations due to clinical and laboratory adverse effects for each drug was analyzed, and these data should be confirmed by other real-life studies. Knowledge of what is happening in real life is essential to health professionals, who need to be aware of the most common adverse effects and to health managers, who aim for greater cost-effectiveness in the choice of medications.
- Bone erosions in rheumatoid arthritis: ultrasound findings in the early stage of the disease(2014) TAMAS, Maria-Magdalena; FILIPPUCCI, Emilio; BECCIOLINI, Andrea; GUTIERREZ, Marwin; GESO, Luca Di; BONFIGLIOLI, Karina; VOULGARI, Paraskevi V.; SALAFFI, Fausto; GRASSI, WalterObjective. The objective of this study was to determine the prevalence and distribution of bone erosions detectable by US in patients with early RA (ERA) in comparison with long-standing RA (LSRA), other erosive diseases and healthy controls. Methods. Thirty patients with ERA and 80 patients with LSRA were consecutively recruited. Thirty patients with PsA, 15 with primary OA, 10 with gout and 20 healthy subjects were included as controls. Bone erosions were investigated at the following anatomical sites: the second and fifth metacarpal heads, the ulnar head and the first and fifth metatarsal heads, bilaterally. Dorsal, volar and lateral aspects were explored on longitudinal and transverse views. Results. At least one US bone erosion was found in 20 (66.7%) of 30 patients with ERA and in 10 (33%) of them it was found on the fifth metatarsal head. Bone erosions were most frequently found on the lateral quadrants of all scanned anatomical sites. If the second and fifth metacarpal heads and the fifth metatarsal head were scanned, an erosive disease could be found in 60% of ERA patients. The first metatarsal head was most frequently involved in the disease control group. Conclusion. This study found a high percentage of ERA patients with US bone erosions, with the fifth metatarsal head and the lateral aspects the most frequently involved site and quadrants. US scanning for bone erosions on a few target joints was found feasible and provided information not obtainable with clinical examination.
- High Levels of Polypharmacy in Rheumatoid Arthritis-A Challenge Not Covered by Current Management Recommendations: Data From a Large Real-Life Study(2021) GOMIDES, Ana Paula M.; ALBUQUERQUE, Cleandro P.; SANTOS, Ana B. V.; AMORIM, Rodrigo B. C.; BERTOLO, Manoel B.; JUNIOR, Paulo L.; SANTOS, Isabela A.; GIORGI, Rina D.; SACILOTTO, Nathalia C.; RADOMINSKI, Sebastiao C.; BORGHI, Fernanda M.; GUIMARAES, Maria F. B. R.; PINTO, Maria R. C.; RESENDE, Gustavo G.; BONFIGLIOLI, Karina R.; CARRICO, Henrique; SAUMA, Maria F. L. C.; SAUMA, Marcel L.; MEDEIROS, Julia B.; PEREIRA, Ivanio A.; CASTRO, Glaucio R. W.; BRENOL, Claiton V.; XAVIER, Ricardo M.; MOTA, Licia M. H.; PINHEIRO, Geraldo R. C.Background: Rheumatoid arthritis (RA) is associated with high frequency of comorbidities and increased risk of polypharmacy. Although there is a great potential for complications, there is a gap in literature on polypharmacy in patients with rheumatic arthritis. Objective: To evaluate the prevalence and factors associated with polypharmacy in a population in a real-life setting. Methods: A cross-sectional multicenter study was conducted in Brazil. Patients underwent clinical evaluation and medical records analysis. Polypharmacy was considered as a dependent variable. To test independent variables, we used Poisson regression. Results: We evaluated 792 patients (89% female, median age 56.6 years). Median duration of disease was 12.7 years, 78.73% had a positive rheumatoid factor. The median of disease activity score-28 was 3.5 (disease with mild activity), median of the clinical disease activity index score was 9, and median of health assessment questionnaire-disability index was 0.875; 47% used corticosteroids, 9.1% used nonsteroidal anti-inflammatory drugs, 90.9% used synthetic disease-modifying antirheumatic drugs, 35.7% used biologic disease-modifying antirheumatic drugs (DMARDs). In total, 537 (67.9%) patients used 5 or more drugs. Polypharmacy showed a relationship with a number of comorbidities and use of specific drugs (corticosteroids, methotrexate, and biological DMARDs). Conclusion: We found a high prevalence of polypharmacy (67.9%) in RA. Solutions to management this problem should be stimulated.
- Performance of the Rheumatoid Arthritis Disease Activity Index in the Assessment of Disease Activity in Rheumatoid Arthritis-Findings From the REAL Study(2022) HADDAD, Pedro Antonio Ramon; VARGAS-SANTOS, Ana Beatriz; COUTINHO, Evandro Silva Freire; PEREIRA, Leticia Rocha; MOTA, Licia Maria Henrique da; ALBUQUERQUE, Cleandro Pires de; GUIMARAES, Maria Fernanda Brandao de Resende; LOUZADA-JUNIOR, Paulo; BONFIGLIOLI, Karina Rossi; SACILOTTO, Nathalia de Carvalho; RADOMINSKI, Sebastiao Cezar; PUGLIESI, Alisson Aliel Vigano; SAUMA, Maria de Fatima Lobato da Cunha; PEREIRA, Ivanio Alves; BRENOL, Claiton Viegas; CASTELAR-PINHEIRO, Geraldo Da RochaBackground/Objective Although telemedicine use has been under discussion for decades, this topic has gained unprecedented importance during the COVID-19 pandemic. The Rheumatoid Arthritis Disease Activity Index (RADAI) is a user-friendly tool, fully self-administered, to assess rheumatoid arthritis (RA) disease activity. The aim of this study was to compare the performance of RADAI with other disease activity indices, functional status, and inflammatory markers in a large cohort of RA patients. Methods We assessed the concurrent validity of RADAI against Clinical Disease Activity Index (CDAI), Disease Activity Score in 28 Joints-C-reactive protein, Disease Activity Score in 28 Joints-erythrocyte sedimentation rate, Simplified Disease Activity Index, and physician assessment of disease activity and the correlation of RADAI with Health Assessment Questionnaire-Disability Index and inflammatory markers at the REAL Study baseline. We also evaluated the correlation of the change in RADAI and the change in CDAI over a 6-month follow-up. Results From the 1115 patients included in the REAL Study, 1113 had RADAI scores in the first assessment. At baseline, correlations between RADAI and other disease activity indices were strong, ranging from 0.64 (comparison with physician assessment) to 0.79 (comparison with CDAI). Correlation between the change in RADAI score over the 6 months of follow-up and the change in CDAI score over the same period was moderate/strong for the overall group and within the stratified analyses. Conclusion The strong correlation of RADAI with other well-established tools for disease activity measurement reassures its use with RA patients' follow-up, especially in this new era of telemedicine.
- 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 CastelarBackgroundEarly 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.