A 29-year-old woman with stage IVB Hodgkin's lymphoma was treated with doxorubicin, bleomycin, vinblastine, and dacarbazine. Two weeks after the first cycle was completed, she developed pruritic, linear erythematous lesions in a flagellate-like pattern on the trunk, neck and arms. After oral prednisone therapy and cessation of bleomycin, the lesions started to recede.

IntroduçãoAtualmente observa-se na prática clínica um considerável aumento da incidência do bruxismo associado a outras alterações do sistema estomatognático 1 . O bruxismo, que consiste no hábito parafuncional de ranger os dentes, constitui um grande desafio para o cirurgião-dentista, pois se trata de uma desordem funcional que exige uma participação multidisciplinar no sentido de reconhecer os fatores etiológicos e promover benefícios ao indivíduo portador dessa patologia 2 . É importante que os profissionais que trabalham com pacientes que apresentam e sofrem com as consequências das desordens do sistema estomatognático e estruturas relacionadas tenham consciência de que também os fatores somáticos, psíqui-cos e sociais podem estar alterados e comprometer o senso normal de bem estar 2 . O bruxismo é o resultado de um distúrbio neuromotor dos músculos mastigatórios, especificamente o bruxismo do sono caracteriza-se por ranger os dentes durante o sono e, geralmente, está associado com despertares de curta duração, conhecidos como microdespertares 3 . O bruxismo noturno difere do bruxismo diurno por envolver: distintos estados de consciência, além de diferentes estados fisiológi-cos. Essa desordem funcional também pode ser clas-

Objectives To evaluate the disease activity before and after COVID-19 and risk factors associated with outcomes, including hospitalization, intensive care unit (ICU) admission, mechanical ventilation (MV) and death in patients with spondylarthritis (SpA). Methods ReumaCoV Brazil is a multicenter prospective cohort of immune-mediated rheumatic diseases (IMRD) patients with COVID-19 (case group), compared to a control group of IMRD patients without COVID-19. SpA patients enrolled were grouped as axial SpA (axSpA), psoriatic arthritis (PsA) and enteropathic arthritis, according to usual classification criteria. Results 353 SpA patients were included, of whom 229 (64.9%) were axSpA, 118 (33.4%) PsA and 6 enteropathic arthritis (1.7%). No significant difference was observed in disease activity before the study inclusion comparing cases and controls, as well no worsening of disease activity after COVID-19. The risk factors associated with hospitalization were age over 60 years (OR = 3.71; 95% CI 1.62–8.47, p = 0.001); one or more comorbidities (OR = 2.28; 95% CI 1.02–5.08, p = 0.001) and leflunomide treatment (OR = 4.46; 95% CI 1.33–24.9, p = 0.008). Not having comorbidities (OR = 0.11; 95% CI 0.02–0.50, p = 0.001) played a protective role for hospitalization. In multivariate analysis, leflunomide treatment (OR = 8.69; CI = 95% 1.41–53.64; p = 0.023) was associated with hospitalization; teleconsultation (OR = 0.14; CI = 95% 0.03–0.71; p = 0.01) and no comorbidities (OR = 0.14; CI = 95% 0.02–0.76; p = 0.02) remained at final model as protective factor. Conclusions Our results showed no association between pre-COVID disease activity or that SARS-CoV-2 infection could trigger disease activity in patients with SpA. Teleconsultation and no comorbidities were associated with a lower hospitalization risk. Leflunomide remained significantly associated with higher risk of hospitalization after multiple adjustments.

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