Rheuma SPACE - Standard Practice Aiming Clinical Excellence: the first Portuguese Rheumatology Department evaluation.

The Portuguese Rheumatology Society (SPR) embraced quality as a major goal and launched, in early 2015, a program to aim for excellence in global clinical care: Rheuma SPACE - Standard Practice Aiming Clinical Excellence. Evaluating daily reality is the first step in a quality development timeline, ultimately contributing for health gains. Herein we describe the results of the evaluation of the quality indicators defined for this project and the improvement strategies identified.

Rheuma SPACE - Standard Practice Aiming Clinical Excellence: description of the methodological approach.

Background: Quality of care is a key component of the right to health, and the route to equity and dignity. The aim of the project Rheuma SPACE - Standard Practice Aiming Clinical Excellence was to develop a set of quality indicators focused in rheumatoid arthritis care and apply them to rheumatology departments of the Portuguese National Health Service in order to benchmark the care for these patients. This article details the methodology that was applied.

PORTUGUESE RECOMMENDATIONS FOR THE USE OF BIOLOGICAL THERAPIES IN PATIENTS WITH PSORIATIC ARTHRITIS--2015 UPDATE.

Objective: To update recommendations for the treatment of psoriatic arthritis with biological therapies, endorsed by the Portuguese Society of Rheumatology (SPR).

Methods: These treatment recommendations were formulated by Portuguese rheumatologists based on literature evidence and consensus opinion. At a national meeting the 16 recommendations included in this document were discussed and updated.

Osteoarthritis medical labelling and health-related quality of life in the general population.

Background: Osteoarthritis is the most common chronic joint disease. In the absence of an effective medical treatment and due to the chronic nature of this condition, an osteoarthritis medical diagnosis may finally result in decreased health-related quality of life. Therefore, the aim of this study was to measure the impact of the osteoarthritis medical labelling on physical and mental health-related quality of life.

Prognostic value of antinuclear antibodies in juvenile idiopathic arthritis and anterior uveitis. Results from a systematic literature review.

Aims: To analyze the prognostic role of antinuclear antibodies (ANA) for the onset of uveitis in the context of juvenile idiopathic arthritis (JIA), its correlation with uveitis course and severity and its prognostic role for the development of arthritis in children with uveitis.

Methods: We conducted a systematic review analysis of the literature on the prognostic value of ANA on JIA associated uveitis and its complications. We included series published between January 1990 and December 2011 reporting the prognostic value of ANA positivity on uveitis in consecutive patients diagnosed with JIA.

Monoclonal gammopathy and rheumatic diseases.

It is common to find monoclonal gammopathy in the investigation workout for an unrelated disorder. There are studies relating rheumatic diseases and therapies which show an increased risk of monoclonal gammopathy. The specific mechanisms are not well understood but chronic antigen stimulation assumes an important role.

[Complex Regional Pain Syndrome--an unusual etiology].

Complex Regional Pain Syndrome type 1 is characterised by neuropathic pain associated with autonomic dysfunctions. It frequently appears after major or minor trauma and more rarely may originate from conditions that compromise the central nervous system. Although few treatments have shown to be effective, their institution at an early stage is decisive for their success.

Portuguese recommendations for the use of biological therapies in patients with axial spondyloarthritis--December 2011 update.

Objective: To develop recommendations for the treatment of axial spondyloarthritis with biological therapies, endorsed by the Portuguese Society of Rheumatology.

Methods: These treatment recommendations were formulated by Portuguese rheumatologists based on literature evidence and consensus opinion. A draft of the recommendations and supporting evidence was first circulated to all Portuguese rheumatologists and their suggestions were incorporated in the draft.

2011 Portuguese recommendations for the use of biological therapies in patients with psoriatic arthritis.

Objective: To develop recommendations for the treatment of psoriatic arthritis (PsA) with biological therapies, endorsed by the Portuguese Society of Rheumatology.

Methods: These treatment recommendations were formulated by Portuguese rheumatologists based on literature evidence and consensus opinion. A draft of the recommendations was first circulated to all Portuguese rheumatologists and their suggestions were incorporated in the draft.

[Practical guide for the use of biological agents in rheumatoid arthritis - December 2011 update].

The authors review the practical aspects of biological therapy use for rheumatoid arthritis patients, commenting safety issues before and after treatment initiation and the best treatment strategies to optimize efficacy.

Portuguese guidelines for the use of biological agents in rheumatoid arthritis - October 2011 update.

The authors present the revised version of the Portuguese Society of Rheumatology (SPR) guidelines for the treatment of Rheumatoid Arthritis (RA) with biological therapies. In these guidelines the criteria for introduction and maintenance of biological agents are discussed as well as the contraindications and procedures in the case of nonresponders. Biological treatment (with a tumour necrosis factor antagonist, abatacept or tocilizumab) should be considered in RA patients with a disease activity score 28 (DAS 28) equal to or greater than 3.

Portuguese guidelines for the use of biological agents in rheumatoid arthritis - March 2010 update.

The authors present the revised version of the Portuguese Society of Rheumatology (SPR) guidelines for the treatment of rheumatoid arthritis (RA) with biological therapies. In these guidelines the criteria for introduction and maintenance of biological agents are discussed as well as the contraindications and procedures in the case of non-responders. Biological treatment should be considered in RA patients with a disease activity score 28 (DAS 28) superior to 3.

Methotrexate treatment in rheumatoid arthritis: management in clinical remission, common infection and tuberculosis. Results from a systematic literature review.

This work was performed as part of the Portuguese participation in the 3E Initiative 2007-2008, dedicated to the use of methotrexate (MTX) in rheumatic conditions. Three questions raised by Portuguese rheumatologists and considered relevant to clinical practice remained out of the selection of a set of ten key questions formulated to further establish multinational recommendations on the use of MTX in rheumatic diseases. The authors collected and analyzed all the evidence available by using a systematic literature search methodology and selection criteria concerning the following issues in rheumatoid arthritis (RA): (1) the management of MTX after clinical remission; (2) the management of MTX during infections and (3) the screening and treatment of tuberculosis in patients on MTX treatment.

[Acute febrile neutrophilic dermatosis - Sweet's syndrome].

In Rheumatology there are several diseases that frequently develop cutaneous manifestations creating diagnostic difficulties. The Sweet's syndrome appears as archetype of the neutrophilic dermatosis,which is a group of not infectious illnesses, characterized for a dermic neutrophilic and angiocentric infiltrated. The four main features that define this syndrome are: cutaneous eruption, fever, peripheral neutrophilia and dermic neutrophilic infiltrated without vasculitis on skin biopsy.

[Rasburicase for tophaceus gout treatment].

The main obstacle to the treatment of hyperuricemia in patients with allergy to allopurinol is the limited availability of equally efficient alternative drugs. The authors present a clinical case of a patient with incapacitant tophaceus gout, allergy to allopurinol and contraindication for uricosurics, who was treated with rasburicase, an urato-oxidase recombinant, based on experience with this drug in tumoral lisis and in some cases reports of tophaceus gout. The authors also enhance the fact of being a patient with a sequelar hemiplegia of a previous cerebrovascular disease that presents tophus only in the not paretic member.

Macroscopic features of knee synovitis in early untreated Behçet disease and psoriatic arthritis.

In a previous study, we found that synovial immunopathology differs between Behçet disease (BD) and psoriatic arthritis (PsA). The objective of this study is to describe the macroscopic features of early untreated knee synovitis in BD and PsA. Fourteen consecutive patients with active early knee synovitis (seven BD and seven PsA) undergoing rheumatologic arthroscopy were assessed.

[Mutilans psoriatic arthritis].

Mutilans arthritis is a rare psoriatic arthritis subtype. The authors present 2 cases of psoriatic mutilans arthritis, who pictures of the hands and feet and their radiographies are very representative of a severe, disfigurant and disability disease.

[Portuguese recommendations for the use of methotrexate in the treatment of rheumatoid arthritis].

Objectives: To develop Portuguese evidence-based recommendations for the use of methotrexate (MTX) in daily clinical practice in rheumatic disorders.

Methods: The Portuguese project was integrated in the multinational 3E Initiative (Evidence, Expertise, Exchange) 2007-2008 where a total of 751 rheumatologists from 17 countries have participated. Ten clinical questions concerning the use of MTX in rheumatic diseases were formulated and the Portuguese group added three more questions.

[Coexistence of primary hyperparathyroidism and multiple myeloma: association and rare manifestations].

Diseases such as multiple myeloma and primary hyperparathyroidism are occasionally found in the elderly. Although very rare, the coexistence of both in the same patient has been described in the literature. The coincidence of manifestations of both diseases, namely hypercalcemia and osteopenia, may difficult the diagnosis, turning it into a challenge.

[Erosive enteropathy in a patient with polyarthritis].

Anaemia is a common clinical feature in patients with rheumatoid arthritis and the coexistence of blood loss may not show an obvious iron deficiency anaemia. The cause may be a cancer or other reason for gastrointestinal bleeding that could be underestimated for being explained as associated with the chronic rheumatic disease. Although less described than gastroduodenal lesions, small bowel damage of non-steroidal anti-inflammatory drugs, used in the treatment of rheumatic diseases, are more common than previously thought.

[Tuberculosis in rheumatic patients treated with tumour necrosis factor alpha antagonists: the Portuguese experience].

In Portugal, 13 cases of tuberculosis (TB) were reported, in the period between 1999 and 2005, in 960 patients exposed to anti-TNFalpha treatment (1.35%), 8 females and 5 males. Mean age was 46.

[Non-steroidal anti-inflammatory drugs and lower intestinal tract toxicity].

In addition to adverse effects on gastroduodenal mucosa, it is recognized that non-steroidal antiinflammatory drugs (NSAIDs) can also induce toxicity to the lower intestinal tract. The diagnostic tools available and the lack of information about its pathogenesis and clinical importance are still limitations for its diagnosis. For their anti-inflammatory and analgesic effects, NSAIDs are largely used to treat musculoskeletal disorders.