Rheumatology International

, Volume 39, Issue 7, pp 1125–1134 | Cite as

Advances in rheumatology practice in Brazil

  • Francisco Airton Castro RochaEmail author
  • Joaquim Ivo Vasques Dantas Landim
  • Leila Nascimento da Rocha


Despite resilient inequities, Brazil has seen progressive improvement in health care in the last 25 years. Infectious diseases rendered place to chronic non-communicable diseases as a major cause of death. Existence of traditional schools of medicine and training services in rheumatology helped form a reasonable number of specialists, though irregular distribution due to the economic issues favoring their clustering in major cities. The Brazilian Society of Rheumatology provides continued medical education, helps training rheumatologists, family physicians and other health professionals and has worked to publish national recommendations for the diagnosis and treatment of major rheumatic diseases. Access to medications and health care facilities is provided for most patients, free of direct charge, including biologics. Specialized services for autoimmune and rare diseases, including pediatric rheumatology and autoinflammatory diseases, have improved, particularly in developed centers of the southern best developed parts of the country. A major unmet need is the lack of access to non-pharmacological treatment modalities. In this article, we will summarize some of the strengths and points that need improvement to enhance access to the rheumatological health care in Brazil.


Arthritis Disease burden Rheumatology Epidemiology 


Author contributions

FACR conceived the article, wrote and approved the final manuscript. JIVDL, LNR—data collection (review and search for references). All authors participated in the preparation and revision of the manuscript, read and approved the final version to be submitted.


This study was partially funded by: Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPQ), Brasil—Grant 459334/2014-0.

Compliance with ethical standards

Conflict of interest

Author Rocha FAC declares that he has no conflict of interest; author Landim JIVD declares that he has no conflict of interest; author da Rocha LN declares that she has no conflict of interest.

Ethical approval

This article does not contain any studies with human participants of animals performed by any of the authors.


  1. 1.
    GBD 2016 Brazil Collaborators (2018) Burden of disease in Brazil, 1990–2016: a systematic subnational analysis for the Global Burden of Disease Study 2016. Lancet 392(10149):760–775. CrossRefGoogle Scholar
  2. 2.
    Smith E, Hoy DG, Cross M, Vos T, Naghavi M, Buchbinder R, Woolf AD, March L (2014) The global burden of other musculoskeletal disorders: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 73:1462–1469. CrossRefGoogle Scholar
  3. 3.
    Storheim K, Zwart J-A (2014) Musculoskeletal disorders and the Global Burden of Disease study. Ann Rheum Dis 73:949–950. CrossRefGoogle Scholar
  4. 4.
    Smolen JS, Landewé R, Bijlsma J, Burmester G, Chatzidionysiou K, Dougados M, Nam J, Ramiro S, Voshaar M, van Vollenhoven R, Aletaha D, Aringer M, Boers M, Buckley CD, Buttgereit F, Bykerk V, Cardiel M, Combe B, Cutolo M, van Eijk-Hustings Y, Emery P, Finckh A, Gabay C, Gomez-Reino J, Gossec L, Gottenberg JE, Hazes JMW, Huizinga T, Jani M, Karateev D, Kouloumas M, Kvien T, Li Z, Mariette X, McInnes I, Mysler E, Nash P, Pavelka K, Poór G, Richez C, van Riel P, Rubbert-Roth A, Saag K, da Silva J, Stamm T, Takeuchi T, Westhovens R, de Wit M, van der Heijde D (2017) EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis 76:960–977. CrossRefGoogle Scholar
  5. 5.
    World Health Organization (2011) 10 facts on health inequities and their causes. World Health Organization, Geneva. Accessed 17 Oct 2018
  6. 6.
    Marmot M (2015) The health gap: the challenge of an unequal world. Lancet 386:2442–2444. CrossRefGoogle Scholar
  7. 7.
    Shapira Y, Agmon-Levin N, Shoenfeld Y (2010) Geoepidemiology of autoimmune rheumatic diseases. Nat Rev Rheumatol 6:468–476. CrossRefGoogle Scholar
  8. 8.
    GEO-RA Group (2017) Latitude gradient influences the age of onset of rheumatoid arthritis: a worldwide survey. Clin Rheumatol 36:485–497. CrossRefGoogle Scholar
  9. 9.
    Handa R (2015) Rheumatology in India–quo vadis? Nat Rev Rheumatol 11:183–188. CrossRefGoogle Scholar
  10. 10.
    Misra DP, Sharma A, Agarwal V (2018) Rheumatology science and practice in India. Rheumatol Int 38:1587–1600. Accessed 17 Oct 2018
  11. 11.
    Senna ER, De Barros AL, Silva EO, Costa IF, Pereira LV, Ciconelli RM, Ferraz MB (2004) Prevalence of rheumatic diseases in Brazil: a study using the COPCORD approach. J Rheumatol 31:594–597Google Scholar
  12. 12.
    Titton DC, Silveira IG, Louzada-Junior P, Hayata AL, Carvalho HM, Ranza R, Rezende LS, Pinheiro GC, Santos JL, Miranda JR, Carvalho JF, Bertolo MB, Freire M, Scheinberg MA, Skare TL, Fernandes V, Bianchi W, Laurindo IM (2011) Brazilian biologic registry: BiobadaBrasil implementation process and preliminary results. Rev Bras Reumatol 51:152–160. CrossRefGoogle Scholar
  13. 13.
    Fafá BP, Louzada-Junior P, Titton DC, Zandonade E, Ranza R, Laurindo I, Peçanha P, Ranzolin A, Hayata AL, Duarte A, Silveira IG, Costa I, Macieira JC, Guedes-Barbosa LS, Bertolo MB, Sauma MF, Silva MB, Freire M, Scheinberg MA, Fernandes V, Bianchi W, Miranda JR, Pinheiro GR, Carvalho HM, Brenol CV, Pereira IA, de Castro GR, de Morais JC, Oliveira SK, de Abreu MM, Toledo RA, Pinheiro MM, Vieira WP, Valim V, BIOBADABRASIL (2015) Drug survival and causes of discontinuation of the first anti-TNF in ankylosing spondylitis compared with rheumatoid arthritis: analysis from BIOBADABRASIL. Clin Rheumatol 34:921–927. CrossRefGoogle Scholar
  14. 14.
    Yonekura CL, Oliveira RDR, Titton DC, Ranza R, Ranzolin A, Hayata AL, Duarte A, Silveira IG, Carvalho HMDS, Moraes JCB, Abreu MM, Valim V, Bianchi W, Brenol CV, Pereira IA, Costa I, Macieira JC, Miranda JRS, Guedes-Barbosa LS, Bertolo MB, Sauma MFLDC, Silva MBG, Freire M, Scheinberg MA, Toledo RA, Oliveira SKF, Fernandes V, Pinheiro MM, Castro G, Vieira WP, Baaklini CE, Ruffino-Netto A, Pinheiro GDRC, Laurindo IMM, Louzada-Junior P (2017) Incidence of tuberculosis among patients with rheumatoid arthritis using TNF blockers in Brazil: data from the Brazilian Registry of Biological Therapies in Rheumatic Diseases (Registro Brasileiro de Monitoração de Terapias Biológicas—BiobadaBrasil). Rev Bras Reumatol Engl Ed 57(Suppl 2):477–483. CrossRefGoogle Scholar
  15. 15.
    Castelar-Pinheiro GR, Vargas-Santos AB, Albuquerque CP, Bértolo MB, Louzada Jr P, Giorgi RDN, Radominski SC, Guimarães MFBR, Bonfiglioli KR, Sauma MFLC, Pereira IA, Brenol CV, Coutinho ESF, da Mota LMH (2018) The REAL study: a nationwide prospective study of rheumatoid arthritis in Brazil. Adv Rheumatol 58:9. CrossRefGoogle Scholar
  16. 16.
  17. 17.
    da Mota LM, Cruz BA, de Albuquerque CP, Gonçalves DP, Laurindo IM, Pereira IA, de Carvalho JF, Pinheiro Gda R, Bertolo MB, Pinto MR, Louzada-Junior P, Xavier RM, Giorgi RD, Lima RA (2015) Update on the 2012 Brazilian Society of Rheumatology Guidelines for the treatment of rheumatoid arthritis: position on the use of tofacitinib. Rev Bras Reumatol 55:512–521. CrossRefGoogle Scholar
  18. 18.
    Gomes RKS, Pires FA, Nobre MRC, Marchi MFS, Rickli JCK (2017) Impact of rheumatoid arthritis in the public health system in Santa Catarina, Brazil: a descriptive and temporal trend analysis from 1996 to 2009. Rev Bras Reumatol Engl Ed 57:204–209. CrossRefGoogle Scholar
  19. 19.
    Ribeiro SL, Albuquerque EN, Bortoluzzo AB, Gonçalves CR, da Silva JA, Ximenes AC, Bértolo MB, Keiserman M, Menin R, Skare TL, Carneiro S, Azevedo VF, Vieira WP, Bianchi WA, Bonfiglioli R, Campanholo C, Carvalho HM, Costa IP, Duarte AL, Kohem CL, Leite NH, Lima SA, Meirelles ES, Pereira IA, Pinheiro MM, Polito E, Resende GG, Rocha FA, Santiago MB, Sauma MF, Valim V, Sampaio-Barros PD, Brazilian Registry of Spondyloarthritis (2016) Quality of life in spondyloarthritis: analysis of a large Brazilian cohort. Rev Bras Reumatol Engl Ed 56:22–27. CrossRefGoogle Scholar
  20. 20.
    Ribeiro SLE, de Campos APB, Palominos PE, Bortoluzzo AB, da Costa MAC, de Oliveira Ribeiro T, Sampaio-Barros PD (2018) Different ethnic background is associated with distinct clinical profiles in the spondyloarthritides in the North and South of Brazil. Clin Rheumatol. (Epub ahead of print) Google Scholar
  21. 21.
    Carneiro S, Bortoluzzo A, Gonçalves C, Silva JA, Ximenes AC, Bértolo M, Ribeiro SL, Keiserman M, Skare T, Menin R, Azevedo V, Vieira W, Albuquerque E, Bianchi W, Bonfiglioli R, Campanholo C, Carvalho HM, Costa ID, Duarte A, Kohem C, Leite N, Lima SA, Meirelles ES, Pereira IA, Pinheiro MM, Polito E, Resende GG, Rocha FA, Santiago MB, Sauma Mde F, Valim V, Sampaio-Barros PD (2013) Effect of enthesitis on 1505 Brazilian patients with spondyloarthritis. J Rheumatol 40:1719–1725. CrossRefGoogle Scholar
  22. 22.
    Saad CGS, Gonçalves CR, Sampaio-Barros PD (2014) Seronegative arthritis in latin America: a current review. Curr Rheumatol Rep 16:438–446. CrossRefGoogle Scholar
  23. 23.
    Ranza R, Carneiro S, Qureshi AA, Martins G, Rodrigues JJ, Romiti R, Barros TB, Carneiro J, Sampaio AL, Grynszpan R, Markus J, Pinto RM, Goldenstein-Schainberg C (2015) Prevalence of psoriatic arthritis in a large cohort of Brazilian patients with psoriasis. J Rheumatol 42:829–834. CrossRefGoogle Scholar
  24. 24.
    Favarato MH, Mease P, Gonçalves CR, Gonçalves Saad C, Sampaio-Barros PD, Goldenstein-Schainberg C (2014) Hypertension and diabetes significantly enhance the risk of cardiovascular disease in patients with psoriatic arthritis. Clin Exp Rheumatol 32:182–187Google Scholar
  25. 25.
    Sampaio-Barros PD, Keiserman M, Meirelles Ede S, Pinheiro Mde M, Ximenes AC, Azevedo VF, Bonfiglioli R, Carneiro S, Ranza R, Bernardo WM, Gonçalves CR, Spondyloarthritis Commision of the Brazilian Society of Rheumatology (2013) Recommendations for the management and treatment of ankylosing spondylitis. Rev Bras Reumatol 53:242–257CrossRefGoogle Scholar
  26. 26.
    Carneiro S, Azevedo VF, Bonfiglioli R, Ranza R, Gonçalves CR, Keiserman M, Meirelles ES, Pinheiro MM, Ximenes AC, Bernardo W, Sampaio-Barros PD, Comissão de Espondiloartrites da Sociedade Brasileira de Reumatologia (2013) Recommendations for the management and treatment of psoriatic arthritis. Rev Bras Reumatol 53(3):227–241CrossRefGoogle Scholar
  27. 27.
    Amorim RBC, Vargas-Santos AB, Pereira LR, Coutinho ESF, da Castelar-Pinheiro R G (2017) Gout treatment: survey of Brazilian rheumatology residents. Clin Rheumatol 36:1179–1188. CrossRefGoogle Scholar
  28. 28.
    Azevedo VF, Lopes MP, Catholino NM, Paiva EDS, Araújo VA, Pinheiro GDRC (2017) Critical revision of the medical treatment of gout in Brazil. Rev Bras Reumatol Engl Ed 57:346–355. CrossRefGoogle Scholar
  29. 29.
    Galluccio F, Walker UA, Nihtyanova S, Moinzadeh P, Hunzelmann N, Krieg T, Steen V, Baron M, Sampaio-Barros P, Kayser C, Nash P, Denton CP, Tyndall A, Müller-Ladner U, Matucci-Cerinic M (2011) Registries in systemic sclerosis: a worldwide experience. Rheumatology 50:60–68. CrossRefGoogle Scholar
  30. 30.
    Pons-Estel BA, Bonfa E, Soriano ER, Cardiel MH, Izcovich A, Popoff F, Criniti JM, Vásquez G, Massardo L, Duarte M, Barile-Fabris LA, García MA, Amigo MC, Espada G, Catoggio LJ, Sato EI, Levy RA, Acevedo Vásquez EM, Chacón-Díaz R, Galarza-Maldonado CM, Iglesias Gamarra AJ, Molina JF, Neira O, Silva CA, Vargas Peña A, Gómez-Puerta JA, Scolnik M, Pons-Estel GJ, Ugolini-Lopes MR, Savio V, Drenkard C, Alvarellos AJ, Ugarte-Gil MF, Babini A, Cavalcanti A, Cardoso Linhares FA, Haye Salinas MJ, Fuentes-Silva YJ, Montandon de Oliveira E, Silva AC, Eraso Garnica RM, Herrera Uribe S, Gómez-Martín D, Robaina Sevrini R, Quintana RM, Gordon S, Fragoso-Loyo H, Rosario V, Saurit V, Appenzeller S, Dos Reis Neto ET, Cieza J, González Naranjo LA, González Bello YC, Collado MV, Sarano J, Retamozo S, Sattler ME, Gamboa-Cárdenas RV, Cairoli E, Conti SM, Amezcua-Guerra LM, Silveira LH, Borba EF, Pera MA, Alba Moreyra PB, Arturi V, Berbotto GA, Gerling C, Gobbi CA, Gervasoni VL, Scherbarth HR, Brenol JCT, Cavalcanti F, Costallat LTL, Da Silva NA, Monticielo OA, Seguro LPC, Xavier RM, Llanos C, Montúfar Guardado RA, Garcia de la Torre I, Pineda C, Portela Hernández M, Danza A, Guibert-Toledano M, Reyes GL, Acosta Colman MI, Aquino AM, Mora-Trujillo CS, Muñoz-Louis R, García Valladares I, Orozco MC, Burgos PI, Betancur GV, Alarcón GS, Grupo Latino Americano de Estudio del Lupus (GLADEL) and Pan-American League of Associations of Rheumatology (PANLAR) (2018) First Latin American clinical practice guidelines for the treatment of systemic lupus erythematosus: Latin American Group for the Study of Lupus (GLADEL, Grupo Latino Americano de Estudio del Lupus)-Pan-American League of Associations of Rheumatology (PANLAR). Ann Rheum Dis 77:1549–1557. CrossRefGoogle Scholar
  31. 31.
    Novak GV, Molinari BC, Ferreira JC, Sakamoto AP, Terreri MT, Pereira RMR, Saad-Magalhães C, Aikawa NE, Campos LM, Len CA, Appenzeller S, Ferriani VP, Silva MF, Oliveira SK, Islabão AG, Sztajnbok FR, Paim LB, Barbosa CM, Santos MC, Bica BE, Sena EG, Moraes AJ, Rolim AM, Spelling PF, Scheibel IM, Cavalcanti AS, Matos EN, Robazzi TC, Guimarães LJ, Santos FP, Silva CT, Bonfá E, Silva CA, Brazilian Childhood-onset Systemic Lupus Erythematosus Group. (2018) Characteristics of 1555 childhood-onset lupus in three groups based on distinct time intervals to disease diagnosis: a Brazilian multicenter study. Lupus 27:1712–1717. CrossRefGoogle Scholar
  32. 32.
    Provenza JR, Shinjo SK, Silva JM, Peron CR, Rocha FA (2015) Combined glucosamine and chondroitin sulfate, once or three times daily, provides clinically relevant analgesia in knee osteoarthritis. Clin Rheumatol 34:1455–1462. CrossRefGoogle Scholar
  33. 33.
    Coimbra IB, Pastor EH, Greve JMD, Puccinelli MLC, Fuller R, Cavalcanti FS, Maciel FMB, Honda E (2002) Brazilian Consensus for the treatment of osteoarthritis. Rev Bras Reumatol 42:371–373Google Scholar
  34. 34.
    Castro da Rocha FA, Ribeiro AR (2003) Low incidence of hip fractures in an equatorial area. Osteoporos Int 14:496–499CrossRefGoogle Scholar
  35. 35.
    Pinheiro MM, Ciconelli RM, Jacques Nde O, Genaro PS, Martini LA, Ferraz MB (2010) The burden of osteoporosis in Brazil: regional data from fractures in adult men and women–the Brazilian Osteoporosis Study (BRAZOS). Rev Bras Reumatol 50:113–127CrossRefGoogle Scholar
  36. 36.
  37. 37.
    Heymann RE, Paiva ES, Martinez JE, Helfenstein M Jr, Rezende MC, Provenza JR, Ranzolin A, Assis MR, Feldman DP, Ribeiro LS, Souza EJR (2017) New guidelines for the diagnosis of fibromyalgia. Rev Bras Reumatol Engl Ed 57(Suppl 2):467–476. CrossRefGoogle Scholar
  38. 38.
    Martinez JE, Paiva ES, Rezende MC, Heymann RE, Helfenstein M Jr, Ranzolin A, Provenza JR, Ribeiro LS, Souza EJR, Feldman DP, Assis MR (2017) EpiFibro (Brazilian Fibromyalgia Registry): data on the ACR classification and diagnostic preliminary criteria fulfillment and the follow-up evaluation. Rev Bras Reumatol Engl Ed 57:129–133. CrossRefGoogle Scholar
  39. 39.
    Sociedade Brasileira de Pneumologia e Tisiologia, Sociedade Brasileira de Infectologia e Sociedade Brasileira de Reumatologia. Projeto Diretrizes da Associação Médica Brasileira e Conselho Federal de Medicina. Tuberculose infecção latente: diagnóstico.
  40. 40.
    Marques CM, Duarte ALBP, Lorena VMB, Souza JR, Souza W, Gomes YM et al (2009) Attenuated response to PPD in the diagnosis of latent tuberculosis infection in patients with rheumatoid arthritis. Rev Bras Reumatol 49:121–125CrossRefGoogle Scholar
  41. 41.
    Musso D, Rodriguez-Morales AJ, Levi JE, Cao-Lormeau VM, Gubler DJ (2018) Unexpected outbreaks of arbovirus infections: lessons learned from the Pacific and tropical America. Lancet Infect Dis. (Epub ahead of print, Review) Google Scholar
  42. 42.
    Zanotto PMA, Leite LCC (2018) The challenges imposed by Dengue, Zika, and Chikungunya to Brazil. Front Immunol 9:1964. CrossRefGoogle Scholar
  43. 43.
    Amaral JK, Schoen RT (2018) Chikungunya in Brazil: rheumatologists on the Front Line. J Rheumatol 45:1491–1492. CrossRefGoogle Scholar
  44. 44.
    Marques CDL, Duarte ALBP, Ranzolin A, Dantas AT, Cavalcanti NG, Gonçalves RSG, Rocha Junior LFD, Valadares LDA, Melo AKG, Freire EAM, Teixeira R, Bezerra Neto FA, Medeiros MMDC, Carvalho JF, Santos MSF, Océa RALC, Levy RA, Andrade CAF, Pinheiro GDRC, Abreu MM, Verztman JF, Merenlender S, Ribeiro SLE, Costa IPD, Pileggi G, Trevisani VFM, Lopes MIB, Brito C, Figueiredo E, Queiroga F, Feitosa T, Tenório ADS, Siqueira GR, Paiva R, Vasconcelos JTS, Christopoulos G (2017) Recommendations of the Brazilian Society of Rheumatology for diagnosis and treatment of Chikungunya fever. Part 1—Diagnosis and special situations. Rev Bras Reumatol Engl Ed 57(Suppl 2):421–437. CrossRefGoogle Scholar
  45. 45.
    Marques CDL, Duarte ALBP, Ranzolin A, Dantas AT, Cavalcanti NG, Gonçalves RSG, Junior LFDR, Valadares LDA, Melo AKG, Freire EAM, Teixeira R, Neto FAB, Medeiros MMDC, Carvalho JF, Santos MSF, Océa RALC, Levy RA, Andrade CAF, Pinheiro GDRC, Abreu MM, Verztman JF, Merenlender S, Ribeiro SLE, Costa IPD, Pileggi G, Trevisani VFM, Lopes MIB, Brito C, Figueiredo E, Queiroga F, Feitosa T, Tenório ADS, Siqueira GR, Paiva R, Vasconcelos JTS, Christopoulos G (2017) Recommendations of the Brazilian Society of Rheumatology for the diagnosis and treatment of Chikungunya fever. Part 2—Treatment. Rev Bras Reumatol Engl Ed 57(Suppl 2):438–451. CrossRefGoogle Scholar
  46. 46.
    Azevedo VF, Meirelles Ede S, Kochen Jde A, Medeiros AC, Miszputen SJ, Teixeira FV, Damião AO, Kotze PG, Romiti R, Arnone M, Magalhães RF, Maia CP, de Carvalho AV (2015) Recommendations on the use of biosimilars by the Brazilian Society of Rheumatology, Brazilian Society of Dermatology, Brazilian Federation of Gastroenterology and Brazilian Study Group on Inflammatory Bowel Disease—focus on clinical evaluation of monoclonal antibodies and fusion proteins used in the treatment of autoimmune diseases. Autoimmun Rev 14:769–773. CrossRefGoogle Scholar
  47. 47.
    Albuquerque CP, Dos Santos-Neto LL (2017) Development of rheumatology training in Brazil: the option for a medical residency program. Rev Bras Reumatol Engl Ed 57(6):507–513. CrossRefGoogle Scholar
  48. 48.
  49. 49.
    de Albuquerque CP (2014) Inequality in the distribution of rheumatologists in Brazil: correlation with local of medical residency, Gross Domestic Product and Human Development Index. Rev Bras Reumatol 54:166–171CrossRefGoogle Scholar
  50. 50. Accessed 17 Oct 2018
  51. 51.
    Andrade LEC, Klotz W, Herold M, Conrad K, Rönnelid J, Fritzler MJ, von Mühlen CA, Satoh M, Damoiseaux J, de Melo Cruvinel W, Chan EKL, Executive Committee of ICAP (2018) International consensus on antinuclear antibody patterns: definition of the AC-29 pattern associated with antibodies to DNA topoisomerase I. Clin Chem Lab Med 56:1783–1788. CrossRefGoogle Scholar
  52. 52.
    Meroni PL, Chan EK, Damoiseaux J, Andrade LEC, Bossuyt X, Conrad K, Mariette X, Sheldon J, Rönnelid J, Fritzler MJ, Members of the Committees (2018) Unending story of the indirect immunofluorescence assay on HEp-2 cells: old problems and new solutions? Ann Rheum DisGoogle Scholar
  53. 53.
    Herold M, Klotz W, Andrade LEC, Conrad K, de Melo Cruvinel W, Damoiseaux J, Fritzler MJ, von Muhlen CA, Satoh M, Chan EKL (2018) International consensus on antinuclear antibody patterns: defining negative results and reporting unidentified patterns. Clin Chem Lab Med 56:1799–1802. CrossRefGoogle Scholar
  54. 54.
    Chan EK, Damoiseaux J, Carballo OG, Conrad K, de Melo Cruvinel W, Francescantonio PL, Fritzler MJ, Garcia-De La Torre I, Herold M, Mimori T, Satoh M, von Mühlen CA, Andrade LE (2015) Report of the first international consensus on standardized nomenclature of antinuclear antibody HEp-2 cell patterns 2014–2015. Front Immunol 6:412. CrossRefGoogle Scholar
  55. 55.
    Francescantonio PL, Cruvinel W, de M, Dellavance, Andrade A, Taliberti LE, von Mühlen BH, Bichara CA, Bueno CD, Mangueira C, Carvalho CL, Bonfá DG, Brito Fde ES, Araújo A, Rêgo FI, Pereira J, dos Anjos KM, Bissoli Mde LM, Santiago F, Maluf MB, Alvarenga NZ, Neves RR, Valim SP, dos Santos V WS (2014) IV Brazilian guidelines for autoantibodies on HEp-2 cells. Rev Bras Reumatol 54:44–50CrossRefGoogle Scholar
  56. 56. Accessed 17 Oct 2018
  57. 57. Accessed 17 Oct 2018
  58. 58.
  59. 59.
  60. 60.
  61. 61.
  62. 62. Accessed 17 Oct 2018
  63. 63.
    Abreu MM, Battisti R, Martins RS, Baumgratz TD, Cuziol M (2011) Shared decision making in Brazil: history and current discussion. Z Evid Fortbild Qual Gesundhwes 105:240–244. CrossRefGoogle Scholar
  64. 64.
    Rodrigues PT, Ferreira AF, Pereira RM, Bonfá E, Borba EF, Fuller R (2008) Effectiveness of medial-wedge insole treatment for valgus knee osteoarthritis. Arthritis Rheum 59:603–608. CrossRefGoogle Scholar
  65. 65.
    Jones A, Silva PG, Silva AC, Colucci M, Tuffanin A, Jardim JR, Natour J (2012) Impact of cane use on pain, function, general health and energy expenditure during gait in patients with knee osteoarthritis: a randomised controlled trial. Ann Rheum Dis 71:172–179. CrossRefGoogle Scholar

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© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Laboratório de Investigação em Osteoartropatias, Department of Internal Medicine, Liga de Reumatologia e Doenças Autoimunes, Instituto de Biomedicina, Faculdade de MedicinaFederal University of CearáFortalezaBrazil

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