Background Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disease that affects synovial joints. Cervical spine damage, due to rheumatoid inflammation, may produces atlantoaxial subluxation that can produce severe neurological symptoms. Early and aggressive treatment with disease-modifying anti-rheumatic drugs (DMARDs) has been shown to prevent cervical spine damage due to RA, but the effect of the biological therapy (BT) in this particular anatomical location, has not been well established. Objectives To analyze the prevalence of the anterior atlantoaxoidal subluxation (AAS) in RA patients receiving biological therapies and to assess possible risk factors. Methods X-Ray of 221 RA patients treated with at least one BT from December 1999 to December 2012 were analyzed. AAS was defined as an anterior atlantoaxoidal distance ≥3mm. All patients diagnosed of AAS prior to BT were excluded from this analysis and X-Ray from the remaining patients were reviewed at two Time points: before (T1) and after initiating the BT (T2). Epidemiological features (i.e. gender, age and age at diagnosis), clinical features (i.e. rheumatoid factor (RF), anti-citrullinated protein antibody (ACPA) and erosions) and previous DMARDs were analyzed. Disease activity was established according to the index DAS28 at T2 radiographic control. The number of BT during the follow-up was also recorded. A survival analysis of AAS was conducted according to two event models, namely (A) interval right-censored analysis [1], and (B) right-censored analysis with mid-point imputation where the time to AAS was approximately the half time between the BT starting date and the AAS positive X-Ray date. Univariate statistical analysis was performed using both the log rank test in models A and B and the Cox's proportional-hazards in model B. The latter was also used to perform the multivariate statistical analysis. Results 58 (26%) patients were excluded from this analysis due to AAS prior BT. A total number of n=163 (74%) patients were analyzed. Of these, 89.5% were women, 73% had positive RF and 76% ACPA positive. Erosions were detected in 77% of patients. After BT initiation, AAS was observed in n=38 (23%) patients. The mean value of the period after starting BT and AAS diagnosis was 2.7 years. In the univariate analysis (i.e. Cox's test), it was found that RF positivity (P-value=8.56e-03), ACPA positivity (P-value=5.22e-03) and DAS28 (P-value=3.59e-03) were associated with AAS development. In multivariate analysis only the presence of ACPA (P-value=8.57e-03) and elevated DAS28 (P-value=0.034) at the time of the X-Ray were associated with development of AAS. The duration of the disease was not significantly associated with the development of the AAS. Conclusions In our series of RA patients, it has been observed that AAS development was present in a substantial subset of patients in spite of having started biological therapy. The main risk factors for AAS development in these subgroup of patients was the presence of ACPA antibodies and hig...

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BACKGROUND: In the last decade, potent immunosuppressive therapy has become the standard treatment for inflammatory bowel disease (IBD) (1). However, the increasingly use of immunomodulators associated to biological therapy—especially the inhibitors of tumor necrosis factor alpha (TNF-α)—have considerably increased the cases of tuberculosis (TB) in IBD patients (2,3). Meanwhile, Brazil is a high TB burden country, with 87,000 new cases per year, and the state of Bahia reports more than 3,600 new cases annually (4,5). METHODS: Were included IBD patients under treatment followed at a referral center from August 2017 to July 2018. The IBD was diagnosed according to the guideline criteria of was according to the criteria the European Crohn's and Colitis Organizsation. Diagnosis of latent TB infection (LTBI) was based on tuberculin skin test (TST) induration ≥5 mm without evidence of clinically manifested active tuberculosis (TB). The development of active TB, diagnosed during the treatment for inflammatory bowel disease, was based on symptoms, TST, chest X ray and laboratory finding. In addition, Sstatistical analysies was performed using the statistical software package SPSS version 21.0 for Windows. A P-value less than 0.05 was considered statistically significant. RESULTS: Of the 302 patients evaluated, 185 were submitted to screening for LTBI and 24 (12.9%) were positive. Of the total sample, 8 (2.6%) developed active TB during treatment for IBD. Six cases occurred despite theof negative screening for LTBI and 2 cases occurred even after chemoprophylaxis with isoniazid. Among 186 UC patients, 4 (2.1%) developed active TB and all cases were pulmonary TB. Two patients were under azathioprine monotherapy (?) with azathioprine and 2 were using 5-ASA derivatives without immunosuppressant. Among 116 Crohn disease (CD) patients, 4 (3.4%) developed active TB, 2 cases of pulmonary TB and 2 cases of pleural TB. All patients with CD who developed active TB were under anti-TNF therapy, 2 under treatment with infliximab monotherapy and 2 with adalimumab combotherapy associated with azathioprine. In total, 63 (20.9%) patients were under biological therapy. The frequency of active TB disease among patients exposed to anti-TNF when compared to patients not exposed was 6.3% (4/63) and 1.7% (4/239), respectively, and the difference was significant (P = 0.047) between those groups. The median time between initiation of anti-TNF therapy and the diagnosis of TB was 19 months (range: 3.0–45.0). CONCLUSION(S): The frequency of latent TB in our center is comparable to the frequency described in IBD patients from endemic countries. It was observed a high frequency of active TB in IBD patients under anti-TNF therapy from a reference center in Brazil. ACKNOWLEDGMENT: Fellowship Program from University of the State of Bahia (PICIN UNEB).

BACKGROUND: In the context of inflammatory bowel disease (IBD), the non-adherence to treatment may negatively affect the patient's clinical evolution, making them more vulnerable to relapses and exacerbations. Despite more than 5 decades of research on the subject, the problem persists in the health system. In order to understand the low adherence it is important to recognize the central role of the patient in this context, without leaving aside the determinants related to treatment and health services. METHODS: It is an observational and cross-sectional study, carried out from June/2017 to July/2018, with questionnaire application and review of medical records in a referral center in IBD in Salvador, Bahia. The study population included patients with IBD diagnosed according to the criteria of European Crohn's2 and Colitis3 Organization and the Morisky-Green4 test was applied to evaluate drug adherence. All statistical analyzes were performed by the statistical software package SPSS version 21.0 for Windows. Chi-square test was used to evaluate association between categorical variables and treatment adherence. For statistical significance, P-value of less than 0.05 was admitted. RESULTS: A total of 302 patients were included, 62.9% female and the mean age was 45.8 years (SD ± 15.05). Of the total sample, 61.6% had ulcerative colitis (UC). Non-adherence was present in 72.5% of the sample. According to disease activity, it was demonstrated that among the 92 patients with Crohn's disease (CD) in remission, 67.4% presented non-adherence; among the 15 individuals in mild to moderate activity, 66.7% were non-adherers and among 11 patients with moderate to severe activity, 72.7% behaved with non-adherence. For UC, of the 142 patients in remission, 75.3% were non-adherers; for 33 patients with mild to moderate activity, 72.7% presented nonadherence and among the 10 patients with severe colitis, 90.0% behaved with nonadherence. Among the 65 patients with side effects, 26.2% were adherers patients, while 73.8% were non-adherers; among the 188 individuals who did not report side effects after the introduction of the drugs for the IBD, 30.9% were adherers patients and 69.1% presented non-adherence. Among the 134 patients in polypharmacy, 69.4% were non-adherers; while those using only IBD therapy, 74.5% behaved with nonadherence. There was no significant statistical difference when comparing non-adherent patients with disease activity in IBD (P = 0.832), side effects after IBD-drug introduction (P = 0.475) and polypharmacy (P = 0.327). CONCLUSION(S): A high frequency of non-adherence was observed in the sample studied, both in Crohn's disease and in ulcerative colitis. The presence of polypharmacy and side effects did not influence in the medication adherence. Patients with more severe inflammatory activity had a lower adherence to therapy in the sample studied, but there was no statistically significant difference when comparing such variables. The findings are similar to those described in other centers.