CAMILLE PINTO FIGUEIREDO

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina

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Autor: FIGUEIREDO, Camille P. ×

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  • article 13 Citação(ões) na Scopus
    Treatment tapering and stopping in patients with rheumatoid arthritis in stable remission (RETRO): a multicentre, randomised, controlled, open-label, phase 3 trial
    (2021) TASCILAR, Koray; HAGEN, Melanie; KLEYER, Arnd; SIMON, David; REISER, Michaela; HUEBER, Axel J.; MANGER, Bernhard; ENGLBRECHT, Matthias; FINZEL, Stephanie; TONY, Hans-Peter; SCHUCH, Florian; KLEINERT, Stefan; WENDLER, Joerg; RONNEBERGER, Monika; FIGUEIREDO, Camille P.; COBRA, Jayme F.; FEUCHTENBERGER, Martin; FLECK, Martin; MANGER, Karin; OCHS, Wolfgang; SCHMITT-HAENDLE, Matthias; LORENZ, Hanns-Martin; NUESSLEIN, Hubert; ALTEN, Rieke; KRUGER, Klaus; HENES, Joerg; SCHETT, Georg; RECH, Juergen
    Background Owing to increasing remission rates, the management of patients with rheumatoid arthritis in sustained remission is of growing interest. The Rheumatoid Arthritis in Ongoing Remission (RETRO) study investigated tapering and withdrawal of disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatoid arthritis in stable remission to test whether remission could be retained without the need to take DMARD therapy despite an absence of symptoms. Methods RETRO was an investigator-initiated, multicentre, prospective, randomised, controlled, open-label, parallel group phase 3 trial in patients aged at least 18 years with rheumatoid arthritis for at least 12 months before randomisation who were in sustained Disease Activity Score using 28 joints with erythrocyte sedimentation rate (ESR) remission (score <2middot6 units). Eligible patients were recruited consecutively from 14 German hospitals or rheumatology practices and randomly assigned (1:1:1) without stratification and regardless of baseline treatment, using a sequence that was computer-generated by the study statistician, to continue 100% dose DMARD (continue group), taper to 50% dose DMARD (taper group), or 50% dose DMARD for 6 months before stopping DMARDs (stop group). Neither patients nor investigators were masked to the treatment assignment. Patients were assessed every 3 months and screened for disease activity and relapse. The primary endpoint was the proportion of patients in sustained DAS28-ESR remission without relapse at 12 months, analysed using a log-rank test of trend and Cox regression. Analysis by a trained statistician of the primary outcome and safety was done in a modified intention-to treat population that included participants with non-missing baseline data. This study is completed and closed to new participants and is registered with ClinicalTrials.gov (NCT02779114). Findings Between May 26, 2010, and May 29, 2018, 303 patients were enrolled and allocated to continue (n=100), taper (n=102), or stop DMARDs (n=101). 282 (93%) of 303 patients were analysed (93 [93%] of 100 for continue, 93 [91%] of 102 for taper, and 96 [95%] of 101 for stop). Remission was maintained at 12 months by 81middot2% (95% CI 73middot3-90middot0) in the continue group, 58middot6% (49middot2-70middot0) in the taper group, and 43middot3% (34middot6-55middot5) in the stop group (p=0middot0005 with log-rank test for trend). Hazard ratios for relapse were 3middot02 (1middot69-5middot40; p=0middot0003) for the taper group and 4middot34 (2middot48-7middot60; p<0.0001)) for the stop group, in comparison with the continue group. The majority of patients who relapsed regained remission after reintroduction of 100% dose DMARDs. Serious adverse events occurred in ten of 93 (11%) patients in the continue group, seven of 93 (8%) patients in taper group, and 13 of 96 (14%) patients in the stop group. None were considered to be related to the intervention. The most frequent type of serious adverse event was injuries or procedural complications (n=9). Interpretation Reducing antirheumatic drugs in patients with rheumatoid arthritis in stable remission is feasible, with maintenance of remission occurring in about half of the patients. Because relapse rates were significantly higher in patients who tapered or stopped antirheumatic drugs than in patients who continued with a 100% dose, such approaches will require tight monitoring of disease activity. However, remission was regained after reintroduction of antirheumatic treatments in most of those who relapsed in this study. These results might help to prevent overtreatment in a substantial number of patients with rheumatoid arthritis. Funding None.
  • conferenceObject
    Performance of FRAX® Brazil and NOGG Methodology with and Without Bone Mineral Density upon Predicting Fractures on a Community-Dwelling Elderly Population with High Incidence of Osteoporotic Fractures - The Sao Paulo Ageing and Health (SPAH) Study
    (2023) FREITAS, Thiago Q.; OLALLA, Leonardo F. Guerron; TAKAYAMA, Liliam; CAPARBO, Valeria F.; FIGUEIREDO, Camille P.; MACHADO, Luana G.; DOMICIANO, Diogo S.; PEREIRA, Rosa M. R.
  • article 4 Citação(ões) na Scopus
    HR-pQCTin vivoimaging of periarticular bone changes in chronic inflammatory diseases: Data from acquisition to impact on treatment indications
    (2021) FIGUEIREDO, Camille P.; PEREZ, Mariana O.; SALES, Lucas Peixoto; SCHETT, Georg; PEREIRA, Rosa M. R.
    Imaging is essential for the assessment of bone and inflammatory joint diseases. There are several imaging techniques available that differ regarding resolution, radiation exposure, time expending, precision, cost, availability or ability to predict disease progression. High-resolution peripheral quantitative computed tomography (HR-pQCT) that was introduced in 2004 allows thein vivoevaluation of peripheral bone microarchitecture and demonstrated high precision in assessing bone changes in inflammatory musculoskeletal diseases. This review summarizes the use of HR-pQCT for the evaluation of the hand skeleton in inflammatory joint diseases. We conducted a review of the literature regarding the protocols that involve hand joints assessment and evaluation of bone changes as erosions and osteophytes in chronic inflammatory diseases. Apart from measuring bone density and structure of the radius and the tibia, HR-pQCT has contributed to assessment of bone erosions and osteophytes, considered the hallmark of diseases as rheumatoid arthritis and psoriatic arthritis, respectively. In this way, there are some conventions recently established by rheumatic study groups that we just summarized here in order to standardize HR-pQCT measurements.
  • article 30 Citação(ões) na Scopus
    A predictive model of vitamin D insufficiency in older community people: From the Sao Paulo Aging & Health Study (SPAH)
    (2014) LOPES, Jaqueline B.; FERNANDES, Georgea H.; TAKAYAMA, Liliam; FIGUEIREDO, Camille P.; PEREIRA, Rosa M. R.
    Objective: To evaluate the prevalence of 25-hydroxyvitamin D insufficiency (25OHD < 20 ng/mL) and to develop a predictive model for this status. Methods: This is a cross-sectional study including 908 community-dwelling older subjects, 18% (158) of which were randomly selected to be a ""test"" sample, with the remaining (750) composing a ""development"" sample. A radioimmunoassay technique was used to measure 25OHD levels. Anthropometrical data, information about lifestyle habits and co-morbidities were obtained. Multiple logistic regression models were created. An Index Risk of Vitamin D Insufficiency (IRVDI) was designed and subsequently validated. The performance of this tool was assessed through ROC analysis. Results: The prevalence of 25OHD <20 ng/mL was of 58.0% (CI 95% 51.6-64.6). The clinical independent factors for 25OHD <20 ng/mL were female gender (OR=2.16; 95%CI 1.13-4.13; p=0.020), diabetes (OR=1.84; 95%CI 1.23-2.74; p=0.003) and season (winter/spring) (OR=3.63, 95%CI 2.62-4.88; p < 0.001). After statistical adjustments, the IRVDI was able to identify older people at risk for vitamin D insufficiency with a sensitivity of 55.9%, specificity 72.3% and ROC area of 0.685 (p < 0.001). Conclusions: Our results suggest that vitamin D insufficiency is common among Brazilian community-dwelling elderly. Female gender, diabetes and the season (winter/spring) were the important parameters that predicted this status. The clinical use of these parameters can be help to design and target appropriate public health interventions. The IRVDI is a convenient tool for the selection of older people at risk for vitamin D insufficiency.
  • article 4 Citação(ões) na Scopus
    Risk Factors for Low Muscle Mass in a Population-based Prospective Cohort of Brazilian Community-dwelling Older Women: The Sao Paulo Ageing & Health (SPAH) Study
    (2020) MACHADO, Ketty L. L. L.; DOMICIANO, Diogo S.; MACHADO, Luana G.; LOPES, Jaqueline B.; FIGUEIREDO, Camille P.; CAPARBO, Valeria F.; TAKAYAMA, Liliam; MENEZES, Paulo R.; PEREIRA, Rosa M. R.
    Introduction: Sarcopenia is characterized by progressive loss of skeletal muscle mass, which results in decreased muscle strength, functional impairment, and increased risk of death. Few studies have performed a concomitant evaluation of clinical, laboratory, and body composition variables to accurately determine the contribution of each parameter to low muscle mass (LMM) in older subjects. This study aimed to identify risk factors (clinical, laboratory parameters, BMD, and body composition by DXA including visceral fat) for LMM in a prospective cohort of older Brazilian women. Methods: A total of 408 women aged >= 65 yr from the Sao Paulo Ageing & Health study were evaluated with clinical data, laboratory bone tests, BMD, and body composition by DXA using Hologic QDR 4500A equipment. Risk factors were measured at baseline (2005-2007). After a follow-up of 4.3 +/- 0.8 yr, subjects were classified according to the LMM definition of the Foundation for the National Institutes of Health criteria. LMM was defined when appendicular lean mass divided by body mass index was less than 0.512. Multivariate logistic regression models were used to identify independent risk factors for LMM. Results: At the end of follow-up, 116 women (28.4%) had LMM. Age averages were 73.3 +/- 4.9 yr in the LMM group and 72.5 +/- 4.5 yr in the normal group (p = 0.11). Mean BMI was 30.6 +/- 5.2 kg/m(2) in the LMM group and 28.1 +/- 4.7 kg/m(2) in the normal group (p < 0.001). In multivariate analyses, predictors of LMM were: falls (OR = 1.14, p = 0.016), TSH levels (OR = 1.08, p = 0.018, per 1 mu UI/L-increase), serum creatinine levels (OR =11.11, p < 0.001, per 1 mg/dL-decrease), and visceral adipose tissue (VAT) mass (OR = 1.17, p < 0.001, per 100 g increase). Conclusions: Falls, high TSH, low creatinine, and high VAT were risk factors for LMM in older women. More attention should be paid to these factors, since they are potentially reversible with adequate intervention.
  • article 1 Citação(ões) na Scopus
    Bone erosions associated with systemic bone loss on HR-pQCT in women with longstanding polyarticular juvenile idiopathic arthritis
    (2023) RIBEIRO, Surian Clarisse C. R.; SALES, Lucas P.; FERNANDES, Alan L.; PEREZ, Mariana O.; TAKAYAMA, Liliam; CAPARBO, Valeria F.; ASSAD, Ana Paula L.; AIWAKA, Nadia E.; GOLDENSTEIN-SCHAINBERG, Claudia; BORBA, Eduardo F.; DOMICIANO, Diogo S.; FIGUEIREDO, Camille P.; PEREIRA, Rosa M. R.
    Objectives: To analyze longstanding polyarticular juvenile idiopathic arthritis (pJIA) for possible associations between localized bone damage (erosions), and systemic bone loss. Besides, to compare the systemic bone mass of pJIA with healthy controls. Methods: Thirty-four pJIA women and 99 healthy controls (HC) were included. Radius and tibia of all subjects were scanned by HR-pQCT. Volumetric bone mineral density (vBMD), bone microarchitecture, and -finite element parameters were analyzed. Patients underwent HR-pQCT of 2nd and 3rd metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of the dominant hand, for bone erosions quantification. Results: The mean age of patients was 31.5 +/- 7.4yrs with a mean disease duration of 21.7 +/- 9.2yrs. Bone erosions were detectable in 79% of patients. The number of bone erosions was positively correlated with cortical porosity (Ct.Po) at tibia (r = 0.575, p = 0.001), and radius (r = 0.423, p = 0.018); and negatively correlated with cortical vBMD at tibia (r=-0.420, p = 0.015). In a logistic regression analysis, adjusted for anti-CCP, the presence of bone erosions was independently associated with Ct.Po at radius (p = 0.018) and cortical vBMD at tibia (p = 0.020). Moreover, cortical and trabecular vBMD, trabecular number, and mu-finite element parameters were decreased in patients compared to HC (p < 0.05). Conclusion: Bone erosions in longstanding pJIA women were associated with decreased cortical bone parameters, and these patients showed systemic bone impairment at peripheral sites compared with healthy controls.
  • conferenceObject
    Effect of Sarcopenia, Subcutaneous Adipose Tissue and Abdominal Visceral Fat on Mortality Risk of Community-Dwelling Older Adults: A Population-Based Prospective Cohort Study
    (2016) SANTANA, Felipe M.; GONCALVES, Michel A.; DOMICIANO, Diogo S.; MACHADO, Luana G.; LOPES, Jaqueline B.; FIGUEIREDO, Camille P.; CAPARBO, Valeria; TAKAYAMA, Liliam; PEREIRA, Rosa M. R.
  • article 43 Citação(ões) na Scopus
    Effects of DMARDs on citrullinated peptide autoantibody levels in RA patients-A longitudinal analysis
    (2017) WUNDERLICH, Carolin; OLIVIERA, Isabelle; FIGUEIREDO, Camille P.; RECH, Juergen; SCHETT, Georg
    Objective: To study whether stable treatment with DMARDs affects anti-CCP2 antibody levels in patients with rheumatoid arthritis. Methods: In this longitudinal observational study 100 RA patients were followed for anti-CCP2 IgG antibody (U/L) and total IgG level (mg/dL) every 6 months for a total period of 2.5 years. All patients received stable DMARD treatment during this period. Five groups comprising each 20 patients were analyzed as follows: (1) methotrexate (MTX) alone, (2) tumor necrosis factor inhibitors (TNFi), (3) tocilizumab (TCZ), (4) rituximab (RTX), and (5) abatacept (ABA). Results: Baseline demographic and disease-specific characteristics were comparable between the 5 groups. Anti-CCP2 antibody levels did not show significant changes in patients treated with MTX (mean +/- SEM: -24.1 +/- 8.1%), TNFi (-14.0 +/- 11.1%) or TCZ (-24.3 +/- 11.3%) between baseline and the 2.5 years follow-up. In contrast, anti-CCP2 antibody levels significantly decreased during treatment with RTX (-75.6 +/- 4.4%) and ABA (-82.5 +/- 3.7%). With respect to total IgG levels, no significant changes were observed with MTX (-1.6 +/- 3.5%), TNFi (-2.5 +/- 3.4%), TCZ (-4.4 +/- 3.1%), or ABA (-2.4 +/- 3.8%) over 2.5 years. In contrast, total IgG levels significantly decreased during treatment with RTX (-22.0 +/- 3.7%). Conclusions: DMARDs targeting the adaptive immune response such as ABA and RTX significantly lowered anti-CCP2 IgG levels, while cytokine inhibitors and methotrexate had no significant effects on anti-CCP2 IgG levels. RTX is the only DMARD, which also lowers total IgG level. (C) 2017 Published by Elsevier Inc.
  • conferenceObject
    Effects of DMARD Tapering on Treatment Costs and Work Productivity in Rheumatoid Arthritis Patients- an Analysis from the Prospective Randomized Controlled Retro- Study
    (2016) HAGEN, Melanie; FIGUEIREDO, Camille P.; COBRA, Jayme Fogagnolo; HASCHKA, Judith; REISER, Michaela; ENGLBRECHT, Matthias; HUEBER, Axel J.; MANGER, Bernhard; KLEYER, Arnd; FINZEL, Stephanie; TONY, Hans-Peter; KLEINERT, Stefan; WENDLER, Joerg; SCHUCH, Florian; RONNEBERGER, Monika; FEUCHTENBERGER, Martin; FLECK, Martin; MANGER, Karin; OCHS, Wolfgang; SCHMITT-HAENDLE, Matthias; LORENZ, H. -M.; NUSSLEIN, H. G.; ALTEN, R.; HENES, Joerg C.; KRUGER, Klaus; SCHETT, Georg; RECH, Juergen
  • article 4 Citação(ões) na Scopus
    KLOTHO polymorphisms and age-related outcomes in community-dwelling older subjects: The SAo Paulo Ageing & Health (SPAH) Study
    (2020) PEREIRA, Rosa Maria R.; FREITAS, Thiago Quadrante; FRANCO, Andre Silva; TAKAYAMA, Liliam; CAPARBO, Valeria F.; DOMICIANO, Diogo S.; MACHADO, Luana G.; FIGUEIREDO, Camille P.; MENEZES, Paulo R.; ONUCHIC, Luiz Fernando; CASTRO, Isac de
    Defective KLOTHO gene expression in mice led to a syndrome resembling human ageing. This study evaluated three KLOTHO polymorphisms, namely G395A, C1818T, and C370S, in an elderly population (mean age of 73 years) and their associations with ageing-related outcomes (cardiovascular events, kidney function, osteoporosis, sarcopenia) and mortality. Estimated glomerular filtration rates (eGFR) was lower in subjects with 1818TT (P=0.047) and 370SS (P=0.046) genotypes. The 1818TT genotype (P=0.006) and 1818T allele were associated with higher frequency of myocardial infarction (MI) (CC:1.7% vs. CT+TT:7.0%; P=0.002). The 370SS genotype was associated with lower stroke frequency (P=0.001). MI (OR 3.35 [95% CI: 1.29-8.74]) and stroke (OR 3.64 [95% CI: 1.48-8.97]) were associated with mortality. Regarding MI, logistic regression showed 1818T allele was a risk factor for death-related MI (OR 4.29 [95% CI: 1.60-11.52]; P=0.003), while 370C was protective (OR 0.03 [95% CI: 0.01-0.08]; P<0.001). Regarding stroke, the 395A and 370C alleles were protective factors (respectively: OR 0.28 [95% CI: 0.20-0.80]; P=0.018; OR 0.10 [95% CI: 0.05-0.18]; P<0.001). This is the first study to determine potential associations between common ageing-related outcomes/mortality and KLOTHO polymorphisms. The 1818T allele was a risk factor for MI-related death. The 395A and 370C alleles were protective factors for stroke-related death in elderly from community.