Browsing by Author "Salgado, M"
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- 2016 Update of the Portuguese Recommendations for the Use of Biological Therapies in Children and Adolescents with Juvenile Idiopathic ArthritisPublication . Santos, MJ; Conde, M; Mourão, AF; Ramos, FO; Cabral, M; Brito, I; Ramos, MP; Marques, RC; Gomes, SM; Guedes, M; Gonçalves, MJ; Estanqueiro, P; Zilhão, C; Rodrigues, M; Henriques, C; Salgado, M; Canhão, H; Fonseca, JE; Gomes, JMTo provide evidence-based guidance for the rational and safe prescription of biological therapies in children and adolescents with juvenile idiopathic arthritis (JIAs) considering the latest available evidence and the new licensed biologics. Rheumatologists and Pediatricians with expertise in Pediatric Rheumatology updated the recommendations endorsed by the Portuguese Society of Rheumatology and the Portuguese Society of Pediatrics based on published evidence and expert opinion. The level of agreement with final propositions was voted using an online survey. RESULTS: In total, 20 recommendations to guide the use of biological therapy in children and adolescents with JIAs are issued, comprising 4 general principles and 16 specific recommendations. A consensus was achieved regarding the eligibility and response criteria, maintenance of biological therapy, and procedures in case of non-response, for each JIA category. Specific recommendations concerning safety procedures were also updated. These recommendations take into account the specificities of each JIA category and are intended to continuously improve the management of JIA patients.
- Association of Body Mass Index with Juvenile Idiopathic Arthritis Disease Activity: a Portuguese and Brazilian Collaborative AnalysisPublication . Neto, A; Mourão, AF; Oliveira-Ramos, F; Campanilho-Marques, R; Estanqueiro, P; Salgado, M; Guedes, M; Piotto, D; Emi Aikawa, N; Melo Gomes, J; Cabral, M; Conde, M; Figueira, R; Santos, MJ; Fonseca, JE; Terreri, MT; Canhão, HObjective: To investigate the relationship between body mass index (BMI) and disease activity in patients with Juvenile Idiopathic Arthritis (JIA). Methods: Patients with JIA, aged ≤18 years, registered at the Rheumatic Diseases Portuguese Register (Reuma.pt) in Portugal and Brazil were included. Ageand sex-specific BMI percentiles were calculated based on WHO growth standard charts and categorized into underweight (P<3), normal weight (3≤P≤85), overweight (8597). Disease activity was assessed by Juvenile Arthritis Disease Activity Score (JADAS-27). Uni- and multivariable analyses were performed. Results: A total of 275 patients were included. The prevalence of underweight, normal weight, overweight and obesity was 6.9%, 67.3%, 15.3% and 10.5%, respectively. Underweight patients had significantly higher number of active joints (p<0.001), patient’s/parent’s global assessment of disease activity (PGA) (p=0.020), physician’s global assessment of disease activity (PhGA) (p<0.001), erythrocyte sedimentation rate (ESR) (p=0.032) and overall higher JADAS-27 (p<0.001), compared to patients with normal weight, overweight and obesity. In the multivariable regression, normal weight (B=-9.43, p<0.01), overweight (B=-9.30, p=0.01) and obesity (B=-9.12, p=0.01) were significantly associated with lower disease activity compared to underweight, when adjusted for age, gender, country, ethnicity, JIA category and therapies used. The diagnosis of RF- (B=3.65, p=0.006) or RF+ polyarticular JIA (B=5.29, p=0.024), the absence of DMARD therapy (B=5.54, p<0.001) and the use of oral GC (B=4.98, p=0.002) were also associated with higher JADAS-27. Conclusion: We found an independent association between underweight and higher disease activity in patients with JIA. Further studies are needed to understand the underlying mechanisms of this association.
- Decisões Clínicas na Doença de CrohnPublication . Magro, F; Correia, L; Lago, P; Macedo, G; Peixe, P; Portela, F; Amil Dias, J; Barros, L; Belo, T; Caldeira, P; Cerqueira, R; Chagas, C; Correia, M; Ferreira, A; Freire, P; Gonçalves, AR; Gonçalves, R; Herculano, R; Lopes, S; Moura Santos, P; Machado, A; Morna, H; Pimentel, R; Ramos, J; Reis, J; Rodrigues, S; Rosa, I; Salgado, M; Vasconcelos, H; Vieira, AIA doença de Crohn é uma doença inflamatória crónica do trato gastrointestinal. O aumento da incidência e a heterogeneidade desta patologia, com diferentes apresentações e prognóstico leva a uma constante preocupação em desenvolver e melhorar a sua classificação e tratamentoObjectivos: Elaborar recomendações (com base no nível de evidência e grau de recomendação) para 5 questões consideradas como os desafios clínicos na abordagem terapêutica da doença de Crohn na actualidade. Métodos: A metodologia adoptada pelo grupo de trabalho DC2 (Desafios Clínicos na Doença de Crohn) baseou‑se na seleção de 5 questões‑problema, por votação; elaboração, por cada subgrupo, de recomendações e reflexões nacionais para cada questão‑problema; discussão e aprovação das respostas e reflexões de cada questão, em reunião de consenso. Conclusões: Foi possível efectuar conclusões alicerçadas na evidência para as questões colocadas, recomendando‑se: 1) são factores preditivos de mau prognóstico o aparecimento da doença de Crohn antes dos 40 anos, doença estenosante e doença anal; 2) poder‑se‑á ponderar suspender os biológicos em doentes com remissão endoscópica e com biomarcadores normais; 3) os doentes com marcadores bioquímicos de atividade (nomeadamente a PCR e a calprotectina) têm maior probabilidade de recidiva; 4) perante uma falência aos biológicos é essencial assegurar que o tratamento com o primeiro fármaco foi optimizado. No caso do infliximab, está demonstrado que quer a redução do intervalo das administrações ou o aumento da dose permitem recuperar a resposta na larga maioria dos doentes. Em relação ao adalimumab, os doentes deverão passar de terapêutica quinzenal para semanal 5) em situação de doença de Crohn com cirurgia intestinal, o recurso a terapêutica de redução da recorrência pós‑cirurgia, particularmente imunossupressores e biológicos está indicado.
- Gene Expression Profiling and Association Studies Implicate the Neuregulin Signaling Pathway in Behçet's Disease SusceptibilityPublication . Xavier, J; Krug, T; Davatchi, F; Shahram, F; Fonseca, B; Jesus, G; Barcelos, F; Vedes, J; Salgado, M; Abdollahi, B; Nadji, A; Moraes-Fontes, MF; Shafiee, N; Ghaderibarmi, F; Patto, J; Crespo, J; Oliveira, SBehçet's disease (BD) is a complex disease with genetic and environmental risk factors implicated in its etiology; however, its pathophysiology is poorly understood. To decipher BD's genetic underpinnings, we combined gene expression profiling with pathway analysis and association studies. We compared the gene expression profiles in peripheral blood mononuclear cells (PBMCs) of 15 patients and 14 matched controls using Affymetrix microarrays and found that the neuregulin signaling pathway was over-represented among the differentially expressed genes. The Epiregulin (EREG), Amphiregulin (AREG), and Neuregulin-1 (NRG1) genes of this pathway stand out as they are also among the top differentially expressed genes. Twelve haplotype tagging SNPs at the EREG-AREG locus and 15 SNPs in NRG1 found associated in at least one published BD genome-wide association study were tested for association with BD in a dataset of 976 Iranian patients and 839 controls. We found a novel association with BD for the rs6845297 SNP located downstream of EREG, and replicated three associations at NRG1 (rs4489285, rs383632, and rs1462891). Multifactor dimensionality reduction analysis indicated the existence of epistatic interactions between EREG and NRG1 variants. EREG-AREG and NRG1, which are members of the epidermal growth factor (EGF) family, seem to modulate BD susceptibility through main effects and gene–gene interactions. These association findings support a role for the EGF/ErbB signaling pathway inBD pathogenesis that warrants further investigation and highlight the importance of combining genetic and genomic approaches to dissect the genetic architecture of complex diseases.