Background Psoriatic arthritis (PsA) is a chronic inflammatory disease of widely varying presentation, which determines functional and psychological impairment, with a high negative impact on patients’ quality of life. Therefore, knowing the patient’s perception of their health status is of fundamental importance for understanding the real impact of PsA. Given this context, the European League Against Rheumatism (EULAR) recently developed the Psoriatic Arthritis Impact of Disease (PsAID) - instrument to specifically assess the impact of PsA for the patient. Objective Validate the brazilian portuguese version of PsAID-12 (Psoriatic Arthritis Impact of Disease) and to verify its interpretability in clinical practice, through its relation with measures of psoriatic arthritis activity. Methods A multicenter cross-sectional study, which recruited 160 patients, who met the Classification criteria for Psoriatic Arthritis (CASPAR), in six Brazilian centers of rheumatology. Reliability was assessed by Cronbach’s alpha coefficient and by the intraclass correlation coefficient (ICC). The construct validity was evaluated by exploratory factorial analysis and also by Spearman correlation with other PROMs and measures of disease activity evaluation. Results Of the total number of participants, 50% were female, with a mean age (SD) of 54.0 ± 11.2 years; 68% had only peripheral arthritis and 32% had pure or mixed axial involvement. The majority (67.7%) of the patients were using biological treatment. The reliability of internal consistency (alpha-Cronbach = 0.93) and test-retest (ICC = 0.996) were good. Factor analysis revealed two factors, named physical and psychosocial, which included the skin evaluation item. PsAID-12 correlated significantly with other PROMs, demonstrating good construct validity. PsAID-12 was also significantly associated with the disease activity assessment instruments (DAS28-ESR, ASDAS, and BASDAI) and the MDA status: “Minimum Disease Activity”. Fibromyalgia did not significantly affect the final PsAID-12 score. Conclusion The brazilian version of PsAID-12 has been shown to be a reliable and valid measure of the impact of the disease in patients with psoriatic arthritis. Moreover, it associated significantly with the scores of disease activity assessment.

Introduction: Despite the high prevalence and high rates of mortality of colorectal cancer, it is likely to be a secondary prevention disease due to the presentation of characteristics that are ideal for a successful screening program, with a proven positive impact on its outcome. Objective: To describe the knowledge and practice of physicians concerning screening tests for the prevention of colorectal cancer. Methods: Cross-sectional study carried out between November 2011 and February 2012, through a questionnaire administered to 83 physicians who assist adult patients at the University Hospital of Universidade Luterana do Brasil and at basic health units of Canoas, Rio Grande do Sul, Brazil. Results: From the number of physicians participating in the survey, only 35 (42.0%) reported prescribing tests for colorectal cancer screening. Out of these, only 21 used the screening on patients aged 50 years old or more, as recommended by the guidelines. Only 65.0% of the physicians reported investigating family history of colorectal cancer, and surgical experts were the ones who least investigated this risk factor (p=0.005), when compared with clinical and gynecology specialties. Conclusions: The number of physicians who reported ordering tests for the prevention of colorectal cancer is still low, and their knowledge regarding the recommendations of the guidelines is very limited. The results indicate the immediate need for investment in professional formation and medical staff training concerning preventive measures for colorectal cancer.

AGRADECIMENTOS À minha mãe -meu diferencial -por enfeitar os meus ondes, firmar os meus passos e se fazer presente, com tanta doçura e leveza, em tudo o que me acontece.Ao meu Pai, por ter me ensinado a ir... Mas, acima de tudo, por ter murado em mim a certeza de que, independente do que intercorra, eu posso voltar para ele me amar.Ao meu irmão Leo -o que nos une e vincula é muito maior que a hemoglobina! É amor, experimentado em cuidado, atenção, cumplicidade, confiança e no inefável que só nós dois conhecemos... Para você, os meus braços e coração abertos! À minha irmã de coração Ana Paula e ao nosso amado Arthur, pelo amor absoluto que nos faz ser família e pelo afeto constante que me impulsiona a seguir... À Re, cunhada-irmã, pela parceria genuína e por oferecer o seu melhor para tornar o meu caminho menos tortuoso. À Thalita, amiga-afilhada, por permanecer ao meu lado com as mãos estendidas e o olhar empático; e por me ajudar, todos os dias, a construir uma versão melhor de mim mesma.Ao meu amigo Caio, exemplo de benevolência, por se fazer disponível não só quando ele pode, mas todas as vezes que a minha limitação se torna maior que eu. Aos Colegas Reumatologistas dos centros coparticipantes deste estudo (Cristiano Campanholo, Jamille Carneiro, Michel Yazbek, Rita de Cássia Menin e Sueli Carneiro)esses resultados e tudo o que advir deles são nossos! Ao meu orientador, Prof. Dr. Carlos Henrique Martins da Silva, por ter aceitado me orientar, ainda sem me conhecer, e por toda confiança depositada no meu trabalho. Ao Prof. Dr. Roberto Ranza, idealizador deste projeto, pela oportunidade de desenvolvê-lo e, principalmente, por me enxergar com lente angular e generosidade -estímulo maior! A Deus, Senhor da minha vida -pela presença tão amorosa em tudo; durante e sempre... Graças, Pai! RESUMO Introdução: A artrite psoriásica é uma doença inflamatória crônica, de apresentação complexa e heterogênea, que acomete um terço dos pacientes brasileiros que tem diagnóstico de psoríase. Ela está comprovadamente associada a comprometimento funcional e psicológico, que determina um elevado impacto negativo na qualidade de vida dos pacientes afetados. Nesse contexto, já foi reconhecida a importância da inclusão de Patient Reported Outcome Measures (PROM) na avaliação da artrite psoriásica, enquanto possibilidade de conhecer o real impacto da doença para o paciente. Porém, até pouco tempo, não existiam PROMs específicos para a doença. Recentemente, foi desenvolvido o Psoriatic Arthritis Impact of Disease (PsAID) , instrumento para avaliar o impacto da doença artrite psoriásica na perspectiva do paciente. Uma versão com doze domínios foi criada exclusivamente para a prática clínica. O PsAID-12 já foi validado com sucesso em países europeus, mas a validação psicométrica da versão em português do Brasil ainda não foi realizada. Além disso, a relação do PsAID-12, medida de impacto da doença, com as medidas de atividade da doença ainda foi pouco estudada. Objetivo: validar a versão em português brasileiro do (PsAID-12) e verificar a...

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BackgroundSynovial tissue is an attractive area of research for biomarkers of disease outcome in RA. Currently acquisition of synovial tissue using an arthroscopic approach in clinical trials is recommended though two US-guided techniques have been described, a portal and forceps (P&F) approach and an adaptation using a quick core needle (NB). However before US-guided biopsy techniques are widely adopted into clinical trials validation of performance against arthroscopy is required.ObjectivesTo evaluate whether there were significant differences in synovial sampling quality and quantity between arthroscopic, US-P&F and US-NB procedures within the context of clinical trials.MethodsThis was a multicentre retrospective analysis of inflammatory arthritis patients recruited to clinical trials utilizing US-guided NB (Barts Health NHS Trust), US-guided P&F (ICRSS Policlinico San Matteo and University Hospital Birmingham) and arthroscopic biopsy (Repatriation General Hospital).Paraffin embedded synovial sections from each procedure underwent H&E staining and sections examined for intact cell lining layer (graded sections). Biopsy procedures were segregated into large (knee) and small joint procedures (wrist/MCP) for analysis. Proportion of samples yielding graded tissue per procedure was recorded. Using CellSens Dimensions software the mean area of synovial tissue obtained per procedure was determined. In addition the degree of synovitis was assessed using semi-quantitiative scoring (0–9).Results78 patient procedures were evaluated, 22 on small joints (11 US-NB, 11 US P&F) and 56 on large joints (11 US-NB, 35 US-P&F, 10 arthroscopic). 47 patients had RA, 11 undifferentiated arthritis and 10 psoriatic arthritis. Arthroscopic sampling resulted in a significantly higher area of tissue retrieved per procedure than US P&F or US-NB. There were no significant differences in proportion of graded samples per procedure suggesting quality of synovial tissue was preserved between techniques. Finally no significant differences in degree of histological synovitis were demonstrated between sampling techniques.Table 1Mean (SD)Small joint biopsiesLarge joint biopsies US –NB (n=11)US P&F (n=11)P valueUS-NB (n=11)US P&F (n=35)Arthroscopic (n=10)P value Joint biopsied7 wrist1 wrist10 knee32 knee10 knee5 MCP10 MCP3 ankle% graded samples per procedure82.3 (22.4)91 (10)0.3489.8 (17.5)83.23 (19)97 (11)0.08Mean area of tissue (mm2) per procedure3.19 (1.75)7.95 (4.91)<0.005*4.66 (3.19)8.8 (8.17)17.64 (7.56)<0.0001*Synovitis score4.9 (3.2)NANA3.8 (2.6)4.53 (2.26)4.5 (1.71)0.35ConclusionsThe results suggest that US-guided biopsy provides a reliable method for sampling synovial tissue of comparable quality to that obtained from arthroscopy. However when sampling large joints arthroscopic techniques, and when sampling small joints US-P&F yield a significantly higher quantity, though not quality, of tissue per procedure than US-NB. These results may influence choice of biopsy technique when designing clinical trial protocols in inflammatory arthritis...