Leonardo Peterson dos Santos

Background: Low muscle mass is associated with physical disability in rheumatoid arthritis (RA), highlighting the need for regular muscle assessment. Muscle ultrasound (MU) is a promising tool for evaluating muscle morphology, however, longitudinal studies in RA are lacking. This study aimed to evaluate changes in quadriceps muscle thickness and pennation angle using MU and identify predictors of these changes. Methods: This prospective observational cohort included women and men with RA. Muscle thickness and pennation angles of the rectus femoris (RF), vastus intermedius (VI), and vastus lateralis (VL) were assessed using MU. Disease activity was measured using the 28-joint Disease Activity Score based on C-reactive protein (DAS28-CRP), muscle strength by the handgrip test, physical performance by Short Physical Performance Battery (SPPB), physical disability by Health Assessment Questionnaire (HAQ), and physical activity by International Physical Activity Questionnaire (IPAQ). Paired t-tests, Pearson and Spearman correlations analyses, and multiple linear regression were conducted (p≤0.05). Result: Among 155 RA patients (88.4% women), 106 completed the 1-year follow-up. The baseline mean age was 58.7±9.5 years, median disease duration was 11.0 (6.0–20.0) years, and mean DAS28-CRP was 3.02±1.29. At follow-up, women exhibited a 7% reduction in VL, 6% in RF, and 4% in VI pennation angles (p≤0.05). Men showed a 39% increase in RF and a 29% in VI muscle thickness (p≤0.05). In women, lower baseline DAS28-CRP and higher muscle strength were correlated with increased muscle thickness (p≤0.05), with DAS28-CRP identified as a predictor of changes in muscle thickness (β=-0.058; CI95%,-0.114 to -0.003). Conclusion: RA women exhibited a decrease in pennation angle, while men had an increase in muscle thickness over time. Disease activity was a significant predictor of these changes in women, underscoring MU’s clinical utility.

Antiphospholipid syndrome (APS) is an autoimmune disorder associated with antiphospholipid antibodies, leading to coagulation imbalance, thrombosis, and obstetric complications. It may occur as a primary condition or in association with systemic lupus erythematosus (SLE). Patients with APS often require long-term anticoagulation therapy, monitored by prothrombin time (PT) expressed as international normalized ratio (INR). Remote laboratory testing (RLT) devices may improve monitoring by providing faster and more convenient results; however, their accuracy in APS patients remains uncertain. This study aimed to validate a rapid and portable device (bSens.INR) for PT/INR measurement in patients with APS and SLE receiving warfarin, compared to a control group without these conditions. Accuracy, repeatability, and agreement with the standard laboratory method were evaluated according to established guidelines. A total of 40 PT/INR measurements were obtained using the bSens.INR and 20 using the standard method. Overall concordance was 77.5%, with lower agreement in APS/SLE patients (60%) compared to controls (95%). Approved results showed 100% repeatability. A strong positive correlation was observed between methods (Spearman r = 0.80, p < 0.0001), while Bland–Altman analysis indicated a bias of 0.26 INR units. The presence of antiphospholipid antibodies appears to interfere with PT/INR measurements obtained by the bSens.INR, reducing accuracy in APS and SLE patients. Although the device shows promising performance, its use in autoimmune populations should be approached with caution, reinforcing previous findings on the limitations of RLT in these conditions.

Introduction: Systemic sclerosis (SSc) often leads to decreased muscle strength and mass, impairing physical performance and causing disability. Interventions with resistance exercise (RE) is an effective non-pharmacological approach to mitigate these issues. This systematic review aims to evaluate the effects of interventions with RE on muscle strength, muscle mass, physical performance, physical disability, and quality of life (QOL) in SSc patients, as well as to assess its adherence and safety. Methods: A systematic review and meta-analysis were conducted based on a PICOS framework: Patient = Systemic Sclerosis; Intervention = Resistance exercise; Study design = Randomized clinical trials. Searches were performed across MEDLINE (PubMed), PMC, Web of Science, Cochrane Library, LILACS, and EMBASE up to January 2025. Results: Ten randomized clinical trials, including 422 participants (~85% female), were eligible for analysis. Participants’ ages ranged from 42 to 64 years, with body mass indices between 22.5 and 28.0 kg/m². The intervention period was standardized to 12 weeks. Interventions with RE significantly improved muscle strength (SMD = 2.76 kg; 95% CI, 1.32 to 4.20; p = 0.0002) and functional disability (SMD = −0.47; 95% CI, −0.93 to −0.00; p = 0.05) compared to controls. Interventions with RE also showed superiority in the physical component of QOL (SMD = 0.42; 95% CI, 0.04 to 0.81; p = 0.03). Although enhanced physical performance was observed, statistical pooling was not possible due to limited data. Interventions with RE had a low incidence of adverse events, but data on disease progression and adherence were insufficient. Conclusion: Interventions with RE benefits muscle strength, physical function, and QOL in SSc patients, though optimal protocols and adherence strategies need further investigation. More robust studies are required to refine training methods and enhance clinical trial designs.

To compare sports motivation, physical activity levels, and muscle strength between patients with Pediatric Rheumatic Diseases (PRD; Juvenile Idiopathic Arthritis [JIA] and pediatric Systemic Lupus Erythematosus [PSLE]) and healthy schoolchildren, and to explore clinical associations, we conducted a cross-sectional study including 28 JIA patients, 19 PSLE patients, and 25 healthy peers matched by age. Disease activity, sports motivation, physical activity, and handgrip strength were assessed using validated tools. PRD patients showed lower motivation for sports, technical development, and enjoyment compared with healthy peers. Physical activity levels were similar between groups, but handgrip strength was lower in PRD patients. In PRD patients, age and waist circumference were associated with motivation and emotional aspects.

The purpose of this research was to perform a systematic review with meta-analysis to compare the effects of resistance training with blood flow restriction (BFR) to the effects of non-training (CON) and traditional resistance training (RT) on strength in elderly people. This was a systematic review with meta-analysis of randomized clinical trials (RCTs), published in English, from inception to 2022, conducted using MEDLINE (PubMed), EMBASE, Web of Science and Cochrane Library. The methodological quality was assessed using GRADE protocol. The risk of bias was assessed using RoB2 software. Standardized mean differences (SMD), mean difference, were pooled using a random-effects model. A p < 0.05 was considered statistically significant. Eight RCT’s were included. We found no significant differences in the effects between BFR and RT (SMD = -0.18 [-0.56 to 0.19]; p = 0.34; I2 = 12%). Also, evidence from our research shows that the effect of BFR is better than non-training (CON) for strengthening in older adults (SMD = 0.63 [0.24 to 1.01]; p = 0.001; I2 = 11%). Our primary findings show that training with BFR may be an alternative methodology of training for the elderly and this training strategy may be interesting for health professionals working with elderly people with low tolerance to high intensity RT.

Introduction: Aerobic protocols and exercises are sought with less overload and that produce gains similar to traditional exercises. Therefore, understanding the changes that occur in incremental test with blood flow restriction(Tmax-BFR) and without blood flow restriction(Tmax-TRAD) is fundamental. Objective: To compare the responses of speeds, ventilatory thresholds(VT), maximum oxygen uptake(VO2max), blood lactate([la]), heart rate(HR) and Borg scale of Tmax-BFR vs. Tmax-TRAD. Methods: In this crossover study, non-athlete men who were submitted to two tests conditions(Tmax-BFR and Tmax-TRAD) were included. Data were analyzed using Generalized Estimating Equations and Bonferroni test. Values p<0.05 were considered significant. Results: Five men were included(Age:22.6±1.1years). The 1stVT, 2ndVT and VO2max were similar in both conditions. However, Tmax-BFR has reached 1stVT(Tmax-TRAD, 9.0±0.7km/h; Tmax-BFR, 8.2±0.5km/h), 2ndVT(Tmax-TRAD, 13.8±1.6km/h; Tmax-BFR, 11.6±1.8km/h) and VO2max(Tmax-TRAD, 15.6±2.9km/h; Tmax-BFR, 13.0±2.1km/h) at significantly lower speeds when compared to Tmax-TRAD(p<0.0001). HR at 2ndVT(Tmax-TRAD, 189.2±20.7bpm; Tmax-BFR, 173.2±10.6bpm; p=0.014) and Maximum HR(Tmax-TRAD, 203.6±14.9bpm; TBFR, 178.8±9.7bpm; p<0.0001) were higher in Tmax-TRAD. The Tmax-BFR showed higher levels of [la] when compared to Tmax-TRAD for 1stVT(p=0.019) and 2ndVT(p=0.005). Conclusion: There was a reduction in speed of 1stVT, 2ndVT and VO2max, as well as lower cardiac effort in the 2ndVT and HR at the end of the test in the Tmax-BFR condition.

To perform a systematic review with meta-analysis to verify muscle strength, muscle mass, and physical function of patients with systemic lupus erythematosus (SLE) and compare then with healthy individuals and patients with rheumatoid arthritis (RA). A systematic review with meta-analysis of observational studies published in English up to 2022 was performed using MEDLINE (via PubMed) and other relevant sources. Search strategies were based on pre-defined keywords and medical subject headings. The methodological quality of the studies was assessed using the Newcastle–Ottawa Scale. Mean difference (MD) or standardized mean difference (SMD) and 95% confidence intervals (CI) were combined using a random-effects model. Sensitivity analyses were performed when necessary. The significance level was set at p < 0.05. The systematic review included 19 studies and the meta-analysis included 11 studies. SLE patients appear to have less muscle strength assessed by handgrip than healthy controls (SLE = 21.74 kg; healthy controls = 29.34 kg; p < 0.05). SLE patients seem to have greater strength than patients with RA, but this difference was not statistically significant (RA = 17.24 kg; p = 0.210). However, in the sensitivity analysis, SLE group without deforming arthropathy showed higher muscle strength than the RA (p = 0.0001). SLE patients with deforming arthropathy have lower muscle strength compared to SLE patients without deforming arthropathy (p < 0.01). Muscle mass was similar in SLE patients compared to the RA group and healthy controls (p > 0.05). However, RA patients have a higher BMI than the two groups (p < 0.05). Patients with SLE have regular physical function. Muscle strength is affected in SLE patients. SLE patients with deforming arthropathy have less muscle strength than patients without deforming arthropathies.

The purpose of this research was to perform a systematic review with meta-analysis to compare the effects of resistance training with blood flow restriction (BFR) to the effects of non-training (CON) and traditional RT on strength in elderly people. This was a systematic review with meta-analysis of randomized clinical trials (RCTs), published in English, from inception to 2022, conducted using MEDLINE (PubMed), EMBASE, Web of Science and Cochrane Library. The methodological quality was assessed using GRADE protocol. The risk of bias was assessed using RoB2 software. Standardized mean differences (SMD), mean difference, were pooled using a random-effects model. A p < 0.05 was considered statistically significant. Eight RCT’s were included. We found no significant differences in the effects between BFR and RT (SMD = -0.18 [-0.56 to 0.19]; p = 0.34; I ² = 12%). Also, evidence from our research shows that the effect of BFR is better than non-training (CON) for strengthening in older adults (SMD = 0.63 [0.24 to 1.01]; p = 0.001; I ² = 11%). Our primary findings show that training with BFR may be an alternative methodology of training for the elderly and this training strategy may be interesting for health professionals working with elderly people with low tolerance to high intensity RT.

Introduction: Self-reported disability is potentially influenced by many factors in patients with rheumatoid arthritis (RA). In this sense, we evaluated the association between self-reported disability and (1) clinical features, (2) muscle strength and (3) physical performance over time among patients with RA from two distinct patient cohorts.Materials and methods: Two independent prospective RA cohorts were analyzed. The Health Assessment Questionnaire (HAQ), Disease Activity Score in 28 Joints (DAS28), handgrip test, chair stand test, timed-up-and-go (TUG) test and Short Physical Performance Battery (SPPB) were performed at baseline and in follow-up. T test for independent samples, Mann-Whitney U test, Spearman correlation coefficients and linear regression with generalized estimating equations were performed to assess associations between individual constructs at baseline and over time.Results: A total of 205 total RA patients were included [North American Cohort (n = 115); Brazilian Cohort (n = 90)]. At enrollment, Brazilian men had better HAQ than North American men (p<0.001). Brazilian patients overall had lower muscle strength than North American patients (p<0.05). HAQ was associated with DAS28, handgrip test, chair stand test, TUG and SPPB (p<0.001) in both cohorts. Worsening of the DAS28 and chair stand test were each associated with worsening in HAQ in longitudinal analysis over time. Worsening of handgrip was also associated in with worsening HAQ in both cohorts (p<0.05). A worse TUG test was associated with worsening in HAQ in Brazilian cohort (p<0.05) and a worse SPPB was associated with worsening in HAQ in North American cohort (p<0.05).Conclusion: Greater disability measured by HAQ is closely associated with disease activity, pain, muscle strength, and physical performance among RA. Worsening in self-reported disability correlate with worsening clinical factors including objectively-observed physical function.