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    751 results match your criteria Acta Reumatologica Portuguesa [Journal]

    1 OF 16

    Shoulder Giant Schwannoma - A Diagnosis To Be Considered In Painless Shoulder Masses.
    Acta Reumatol Port 2017 Nov 5. Epub 2017 Nov 5.
    Centro Hospitalar do Baixo Vouga, E.P.E.
    Tumours formed from peripheral nerve sheaths are rare in the shoulder. We present the case of a 80-year-old female referred to an orthopaedic surgery clinic because of a large painless mass of the right shoulder, with one year of evolution. There was no history of trauma, involvement of any other joint or systemic complaints. Read More

    Patients with newly diagnosed Rheumatoid Arthritis are at increased risk of Diabetes Mellitus: An Observational Cohort study.
    Acta Reumatol Port 2017 Sep 28. Epub 2017 Sep 28.
    Odense University Hospital, Svendborg Hospital.
    Aims: To reveal the prevalence of Diabetes Mellitus (DM) in patients with newly diagnosed Rheumatoid Arthritis (RA) and evaluate the association between clinical characteristics of RA and DM as well as treatment response in newly diagnosed RA patients with DM.

    Methods: Newly diagnosed, adult, RA patients, who were registered in Danish Danbio since 1st January 2010, were included. Patients' demographics, serology results including rheumatoid factor (RF), anti-cyclic citrullinated peptide antibody (anti-CCP) and antinuclear antibody (ANA) as well as disease activity score in 28 joints-C-reactive protein (DAS28-CRP) at the time of diagnosis and after 4 months (±1-2 months) of treatment initiation were extracted from Danbio Registry. Read More

    Reuma.pt contribution to the knowledge of immune-mediated systemic rheumatic diseases.
    Acta Reumatol Port 2017 Jul-Sep;42(3):232-239
    Centro Hospitalar Baixo Vouga.
    Patient registries are key instruments aimed at a better understanding of the natural history of diseases, at assessing the effectiveness of therapeutic interventions, as well as identifying rare events or outcomes that are not captured in clinical trials. However, the potential of registries goes far beyond these aspects. For example, registries promote the standardization of clinical practice, can also provide information on domains that are not routinely collected in clinical practice and can support decision-making. Read More

    Erythema elevatum diutinum in Crohn's disease-associated Spondyloarthritis - a rare vasculitis, an unusual association.
    Acta Reumatol Port 2017 Sep 14. Epub 2017 Sep 14.
    Erythema elevatum diutinum is a rare neutrophilic dermatoses with vasculitis, which presents as persistent, symmetrical, purple or brownish papules and nodules, mainly in the extensor surface of the limbs. We describe a case of erythema elevatum diutinum and polyarthritis as initial manifestations of Crohn's disease associated spondyloarthritis. A 51-year-old man, from São Tomé e Príncipe, with previous history of treated tuberculosis and chronic hepatitis B infection, was admitted due to 4 months history of polyarthritis, hyperpigmented papules on the extensor surfaces, occasional episodes of bloody mucous diarrhea and significant weight loss. Read More

    The Portuguese Society of Rheumatology position paper on the use of biosimilars - 2017 update.
    Acta Reumatol Port 2017 Jul-Sep;42(3):219-228
    Biosimilars are new and more affordable similar versions of previously approved reference biological drugs. Following the approval of the first monoclonal antibody biosimilar in 2013, the Portuguese Society of Rheumatology issued a position paper on the use of biosimilars in rheumatic conditions covering efficacy, safety, extrapolation, interchangeability, substitution and pharmacovigilance. However, as this is a rapidly evolving field, it was felt that the knowledge and evidence gathered since then justified an update of these statements. Read More

    Portuguese recommendations for the use of biological therapies in patients with axial spondyloarthritis - 2016 update.
    Acta Reumatol Port 2017 Jul-Sep;42(3):209-218
    Rheumatology and Metabolic Bone Diseases Department, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon Academic Medical Centre, Lisbon, P.
    Objective: To update the recommendations for the treatment of axial spondyloarthritis (axSpA) 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. At a national meeting, the 7 recommendations included in this document were discussed and updated. Read More

    Translation and cross-cultural adaptation of the ASAS Health Index and ASAS Environmental Factors Item Set into European Portuguese Language.
    Acta Reumatol Port 2017 Jul-Sep;42(3):256-262
    CEDOC; NOVA Medical School| Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisboa; Centro Hospitalar de Lisboa Ocidental, Hospital de Egas Moniz, Lisboa.
    Objective: There is a lack of outcome measures to assess the impact of axial spondyloarthritis (axSpA) on health, function and quality of life. The Assessment of SpondyloArthritis International Society (ASAS) group developed the ASAS Health Index (ASAS-HI) and the ASAS Environmental Factors Item Set (ASAS-EF) to measure functioning and health across all aspects of health that are typically affected and relevant for patients with axSpA, based on the International Classification of Functioning, Disability and Health (ICF). The aim of this paper was to describe the translation and cross-cultural adaptation of both questionnaires into European Portuguese among patients with radiographic and non-radiographic axial SpA (nr-axSpA) and test the conceptual equivalence of the translated version in the Portuguese context. Read More

    Axial involvement according to ASAS criteria in an observational psoriatic arthritis cohort.
    Acta Reumatol Port 2017 Apr-Jun;42(2):176-182
    The definition of axial involvement in psoriatic arthritis (PsA) is still under debate. Currently, the axial spondyloarthritis (SpA) criteria defined by Assessment of Spondyloarthritis International Society (ASAS) may be the most adequate.(1) The aims of present study were to assess axial involvement according to ASAS criteria in an observational PsA cohort and define the clinical characteristics more associated with this kind of involvement. Read More

    Anticentromere antibody positive Ackerman's Syndrome with Granulomatous Anterior Uveitis.
    Acta Reumatol Port 2017 Jul-Sep;42(3):277-278
    Instituto Português de Reumatologia.
    Ackerman's Syndrome or Intersticial Granulomatous Dermatitis with Arthritis has been an issue of increasing number of reports in the last decade which had focused its heterogeneous cutaneous and rheumatologic expression besides the initial manifestations reported by Ackerman and his group. Granulomatosis anterior uveitis has not been previously described. Some patients are reported to have positive autoantibodies but association with anticentromere antibodies has not been previously described as well, to our knowledge. Read More

    Radiculopathy in a patient with chronic tophaceus gout: vertebral imaging.
    Acta Reumatol Port 2017 Jul-Sep;42(3):269-270
    Instituto Portguês de Reumatologia.
    Introduction: Spinal involvement is infrequent in chronic gout. However, some cases of back pain with radiculopathy secondary to this etiology have been reported.

    Case Report: 56-year old male patient, with history of arterial hypertension, hypertriglyceridemia, obesity, glucose intolerance and alcohol abuse, diagnosed with gout in his fifth decade of life. Read More

    Portuguese recommendations for the use of methotrexate in rheumatic diseases - 2016 update.
    Acta Reumatol Port 2017 Apr-Jun;42(2):127-140
    on behalf of the Portuguese Society of Rheumatology.
    Background: Methotrexate (MTX) is the first-line drug in the treatment of rheumatoid arthritis (RA) and the most commonly prescribed disease modifying anti-rheumatic drug. Moreover, it is also used as an adjuvant drug in patients under biologic therapies, enhancing the efficacy of biologic agents.

    Objectives: To review the literature and update the Portuguese recommendations for the use of MTX in rheumatic diseases first published in 2009. Read More


    Systemic sclerosis induced by interferon-alfa treatment of melanoma.
    Acta Reumatol Port 2017 Jul-Sep;42(3):263-264
    Systemic sclerosis is a connective tissue disease characterized by a complex pathogenesis and a multi organ involvement of unknown etiology. Genetic features and environmental factors, as the use of some drugs, influence the onset of the clinical picture. The authors describe a case of a patient who developed systemic sclerosis after treatment of melanoma with interferon alfa-2b, drug rarely implicated in the induction of this disease. Read More

    Polymorphism rs2275913 of Interleukin-17A is related to more intensive therapy with disease-modifying anti rheumatic drugs in Mexican patients with Rheumatoid Arthritis.
    Acta Reumatol Port 2017 Apr-Jun;42(2):155-161
    Escuela Superior de Medicina, Instituto Politécnico Nacional.
    Aim: The study has two aims: 1) to evaluate the association of IL-17 polymorphism rs2275913 with RA severity and 2) to evaluate if this particular SNP is associated with susceptibility for RA in Mexican patients.

    Methods: Seventy-six RA patients and ninety-four healthy controls were included in the study. RA patients were evaluated according to DAS 28. Read More

    Stevens-Johnson syndrome and toxic epidermal necrolysis in childhood-onset systemic lupus erythematosus patients: a multicenter study.
    Acta Reumatol Port 2017 Jul-Sep;42(3):250-255
    Universidade Federal de São Paulo (UNIFESP).
    Objective: To assess Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in a large population of childhood-onset systemic lupus erythematosus (cSLE) patients.

    Methods: Multicenter study including 852 cSLE patients followed in Pediatric Rheumatology centers in São Paulo, Brazil. SJS was defined as epidermal detachment below 10% of body surface area (BSA), overlap SJS-TEN 10-30% and TEN greater than 30% of BSA. Read More

    Lupus protein-losing enteropathy patient with protein C and protein S deficiency-induced thrombosis: A case report with review of the literature.
    Acta Reumatol Port 2017 Jul-Sep;42(3):265-268
    Faculty of Medicine; Thammasat University.

    A case report of SLE with PLE in an Asian female; presented with edema, pleural effusion, ascites and profound hypoalbuminemia. She also had severe protein C and protein S depletion from GI loss which caused extensive thrombosis. Her disease was refractory to the treatment with high dose steroid, azathioprine, mycophenolate mofetil and cyclophosphamide. Read More


    Axial involvement according to ASAS criteria in an observational psoriatic arthritis cohort.
    Acta Reumatol Port 2016 Oct 20. Epub 2016 Oct 20.
    The definition of axial involvement in psoriatic arthritis (PsA) is still under debate. Currently, the axial spondyloarthritis (SpA) criteria defined by Assessment of Spondyloarthritis International Society (ASAS) may be the most adequate.(1) The aims of present study were to assess axial involvement according to ASAS criteria in an observational PsA cohort and define the clinical characteristics more associated with this kind of involvement. Read More

    CD13/aminopeptidase N mRNA expression and enzyme activity in Systemic Lupus Erythematosus.
    Acta Reumatol Port 2017 Apr-Jun;42(2):162-167
    Shahid Beheshti University of Medical Sciences, Tehran, Iran.
    Aims: To determine the significance of CD13/aminopeptidase N (APN) in systemic Lupus Erythromatus (SLE), we examined its catalytic activity and mRNA expression level in sera and peripheral whole blood cells of patients with SLE.

    Methods: In this study, 47 SLE patients and 44 age, sex matched healthy controls were included. The SLE disease activity index score and clinical finding including renal involvement and blood pressure were recorded. Read More

    Risk factors for late deep infection after total hip arthroplasty in patients with rheumatoid arthritis.
    Acta Reumatol Port 2017 Apr-Jun;42(2):150-154
    Kobe University Graduate School of Medicine.
    Objective: Postoperative infections, a serious complication of orthopedic surgery, occur 2-4 times more frequently in patients with rheumatoid arthritis (RA) without adjustment for medication. Some studies have demonstrated a similar risk of postoperative infection following orthopedic surgery regardless of whether patients underwent tumor necrosis factor-α (TNF-α) inhibitor therapy; however, other studies have reported a higher risk with TNF-α inhibitor use. However, few reports have focused on the correlation between TNF-α inhibitor use and postoperative late infection. Read More

    Primary Breast Lymphoma with cutaneous involvement in a patient with Rheumatoid Arthritis - a complication of infliximab therapy?
    Acta Reumatol Port 2017 Apr-Jun;42(2):191-195
    Centro Hospitalar e Universitário de Coimbra.
    It is well established that rheumatoid arthritis is associated with an increased risk of lymphoma. The use of tumor-necrosis factor-α inhibitors as a therapy in rheumatoid arthritis has been related to higher incidence of lymphoma arising at atypical and/or unusual locations; however, recent data shows their safety. We report the case of a 79 year-old woman with rheumatoid arthritis treated with infliximab, who presented a primary breast lymphoma with cutaneous involvement. Read More

    UVA1 for diffuse cutaneous systemic sclerosis in a Fitzpatrick skin type VI patient: outcomes in the modified Rodnan skin score.
    Acta Reumatol Port 2017 06;42(2)(Apr-Jun):196-197
    Centro Hospitalar e Universitário de Coimbra.
    Introduction: Cutaneous sclerosis can lead to important mobility impairment. Ultraviolet (UV) A1 phototherapy may improve skin sclerosis, although most of the studies have been with Caucasian patients.

    Material And Methods: A 44-year-old patient, Fitzpatrick skin type VI, was being followed up with the diagnosis of diffuse cutaneous systemic sclerosis. Read More

    Real-life effectiveness of Golimumab in biologic-naïve patients with rheumatoid arthritis - data from the Rheumatic Diseases Portuguese Register (Reuma.pt).
    Acta Reumatol Port 2017 06;42(Apr-Jun):141-149
    Faculdade de Ciências Médicas da Universidade Nova de Lisboa.
    Objectives: To assess the effectiveness of subcutaneous Golimumab 50 mg/monthly combined with methotrexate (SC GLM + MTX) over 52 weeks of treatment, in biologic-naïve RA patients, in a multicentre nationwide cohort from the Rheumatic Diseases Portuguese Register (Reuma.pt).

    Methods: Data for this observational study was collected from March 2011 to August 2015. Read More

    Interventions aiming to reduce early retirement due to rheumatic diseases.
    Acta Reumatol Port 2017 Jul-Sep;42(3):240-248
    NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), Lisboa, Portugal.
    Introduction: Aging of the population and early retirement translates into productivity losses to society. Persistence of working life is crucial to counteract this sustainability issue faced by western countries. Musculoskeletal and rheumatic diseases (RD) may cause work disability and early exit from work, including early retirement. Read More

    Elastofibroma dorsi: a forgotten cause of chest pain.
    Acta Reumatol Port 2017 Jan-Mar;42(1):91-93
    Hospital de Braga.
    Objectives: Elastofibroma dorsi is an uncommon benign tumor, typically located in the subscapularis region. Our goal is to describe the main features of elastofibroma dorsi to increase awareness of its existence and proper management.

    Material And Methods: We report a case of a 59-year-old woman with bilateral Elastofibroma dorsi and made a brief review of the epidemiological, clinical and radiodiagnostic features of this entity. Read More

    Tofacitinib suppresses disease activity and febrile attacks in a patient with coexisting rheumatoid arthritis and familial Mediterranean fever.
    Acta Reumatol Port 2017 Jan-Mar;42(1):88-90
    Erciyes University, Faculty of Medicine.
    Familial Mediterranean fever (FMF) is the most common hereditary auto-inflammatory (periodic fever) syndrome, and usually successfully treated with colchicine. However, nearly 5-10% of FMF cases are resistant or intolerant to colchicine and treatment options are highly restricted in these cases. Biologics including anakinra, canakinumab, rilonacept, etanercept, infliximab, interferon-alpha, and tocilizumab are shown to have efficacy to control FMF attacks. Read More

    Pachymeningitis and cerebral granuloma in granulomatosis with polyangiitis: is rituximab a promising treatment option?
    Acta Reumatol Port 2017 Jan-Mar;42(1):82-87
    Centro Hospitalar e Universitário de Coimbra.
    Granulomatosis with polyangiitis (GPA) is a rare autoimmune disease characterized by granulomatous inflammation involving upper and lower respiratory tract, kidneys and peripheral nervous system. However, central nervous system involvement is uncommon and frequently refractory to classical therapy. Rituximab has emerged as promising alternative, but published reports are scarce. Read More

    Portuguese translation, cross-cultural adaptation and reliability of the questionnaire «Start Back Screening Tool» (SBST).
    Acta Reumatol Port 2017 Jan-Mar;42(1):38-46
    Universidad da Extremadura.
    Objective: To translate and perform the cross-cultural adaptation of the StarT Back Screening Tool (SBST) questionnaire to assessment and screening low back pain for Portuguese application, and test their reliability.

    Method: To establish conceptual equivalence in item, semantic and operational concern, there were performed two translations into Portuguese in a independently way. A combined version was obtained by consensus among the authors of the translations in order to be achieved a noticeable version in semantic terms and easy to understand. Read More

    The effects of acupuncture versus sham acupuncture in the treatment of fibromyalgia: a randomized controlled clinical trial.
    Acta Reumatol Port 2017 Jan-Mar;42(1):32-37
    Yıldırım Beyazıt University Medical School.
    Objective: The aim of this manuscript is to determine and to compare the efficacy of real acupuncture with sham acupuncture on fibromyalgia (FM) treatment.

    Methods: 50 women with FM were randomized into 2 groups to receive either true acupuncture or sham acupuncture. Subjects were evaluated with VAS (at night, at rest, during activity), SF-36, Fibromyalgia Impact Questionnaire (FIQ), Beck Depression scale (BDI), Fatigue Severity Scale (FSS) at baseline, 1 month and 2 months after the 1st session. Read More

    Carbonic anhydrase I and II autoantibodies in Behçet's disease.
    Acta Reumatol Port 2017 Jan-Mar;42(1):26-31
    Faculty of Engineering and Natural Sciences, Gumushane University.
    Background: Behçet's disease is a vasculitis, seen more frequently around the Mediterranean and the Far East, and evinces with oral and genital ulcerations, skin lesions and uveitis. Carbonic anhydrase (CA) is a metalloenzyme which is widely distributed in the living world, and it is essential for the regulation of acid-base balance. Anti-CA antibodies have been reported in many disorders, such as systemic lupus erythematosus, Sjögren's syndrome, rheumatoid arthritis, endometriosis, idiopathic chronic pancreatitis, type 1 diabetes and Graves' disease. Read More

    Efficacy and Safety of Vaccination in Pediatric Patients with Systemic Inflammatory Rheumatic Diseases: a systematic review of the literature.
    Acta Reumatol Port 2017 Jan-Mar;42(1):8-16
    Hospital Garcia de Orta.
    Introduction: Children and adolescents with systemic rheumatic diseases have an increased risk of infections. Although some infections are vaccine-preventable, immunization among patients with juvenile rheumatic diseases is suboptimal, partly due to some doubts that still persist regarding its efficacy and safety in this patient population.

    Objectives: To review the available evidence regarding the immunological response and the safety of vaccination in children and adolescents with systemic inflammatory rheumatic diseases (SIRD). Read More

    Digital Ischemia as a paraneoplastic phenomenon.
    Acta Reumatol Port 2016 Oct-Dec;41(4):378-379
    Centro Hospitalar do Baixo Vouga, E.P.E.
    Digital ischemia is a rare paraneoplastic phenomenon associated with several malignant tumours, particularly adenocarcinomas. The underlying pathogenic mechanisms remain unknown and it can be the first manifestation, occur after the diagnosis or during treatment. We report a case of a 50 year old woman presenting with digital ischemia, whose diagnostic workup led to an invasive breast cancer, with significant improvement of digital ischemia after a successful treatment of the neoplasm. Read More

    Ibuprofen plus paracetamol versus ibuprofen in acute low back pain: a randomized open label multicenter clinical study.
    Acta Reumatol Port 2017 Jan-Mar;42(1):18-25
    Objective: to estimate whether combination of ibuprofen and paracetamol is more effective than ibuprofen in monotherapy, in the treatment of acute low back pain.

    Methods: 80 adult patients with acute low back pain were randomized into two subgroups. In the first subgroup, 40 patients were treated with ibuprofen 400mg three times a day (TID), whilst patients in the second subgroup (n=40) were treated with a fixed-dose combination tablet of ibuprofen 200mg plus paracetamol 325mg TID, for three consecutive days. Read More

    Comorbidities in Turkish patients with rheumatoid arthritis: association with the health-related quality of life in terms of disease activity, functional and radiological status, severity of pain, and social and emotional functioning.
    Acta Reumatol Port 2016 Oct-Dec;41(4):344-349
    Ankara Numune Training and Research Hospital.
    Aims: The aim of our study was to investigate the comorbidities in Turkish RA patients and evaluate the impact of comorbidities on health-related quality of life (HRQoL) in terms of disease activity, functional and radiological status, severity of pain, and social and emotional functioning.

    Methods: In a cross-sectional setting, a total of 160 RA patients who were admitted to our outpatient clinic between December 2013 and February 2014 were consecutively enrolled in the study. Comorbidities were recorded. Read More

    Effect of rheumatoid arthritis on strength, dexterity, coordination and functional status of the hand: the relationship with magnetic resonance imaging findings.
    Acta Reumatol Port 2016 Oct-Dec;41(4):328-337
    Ankara Training and Research Hospital, Ankara, Turkey.
    Objective: To evaluate the effect of rheumatoid arthritis (RA) on strength, dexterity, coordination and functional status of the hand and to determine the relation with magnetic resonance imaging (MRI) findings.

    Materials And Methods: Thirty eight patients with RA and thirty three controls were included in the study. There were five drop-outs in RA group. Read More

    Psychometric properties of the Revised Fibromyalgia Impact Questionnaire (FIQR) - a contribution to the Portuguese validation of the scale.
    Acta Reumatol Port 2016 Jul-Sep;41(3):240-250
    Background: Fibromyalgia (FM) remains a relatively misunderstood and clinically challenging condition that impact significantly in the individual´s life, impairing global functioning and diminishing quality of life. Management is complex and frequently unsatisfactory, requiring personal tailoring and adaptation of interventions according to the fluctuations of the disease manifestations and their response to therapy. The use of comprehensive and quantified assessment tools constitutes, therefore, an essential component of the management of patients with FM. Read More

    Human papillomavirus infection and cervical lesions in rheumatic diseases: a systematic review.
    Acta Reumatol Port 2016 Jul-Sep;41(3):184-190
    An association between immune-mediated diseases and cervical pre-malignant and malignant lesions is described, having the human papillomavirus (HPV) infection a causal role. Related studies have been generally focused on systemic lupus erythematosus (SLE) patients, but relatively to other diseases, such as rheumatoid arthritis (RA), Sjögren's syndrome (SS) and systemic sclerosis (SSc), data has not been systematically evaluated. We conducted a systematic review analysis of the literature in PubMed, including articles published until March of 2015, in patients with RA, SS, SLE and SSc, to evaluate the frequency of HPV infection, cervical dysplasia and cervical cancer, and associated factors, with particular interest on the role of glucocorticoids and immunosuppressive treatment. Read More

    Incidence and predictors of cardiovascular events in a cohort of patients with rheumatoid arthritis.
    Acta Reumatol Port 2016 Jul-Sep;41(3):213-219
    Introduction: An excess in cardiovascular (CV) morbidity and mortality has been recognized in Rheumatoid Arthritis (RA) patients when compared to the general population. Given the paucity of prospective data, our aim was to estimate the incidence of CV events and the contribution of traditional CVD risk factors and RA-related parameters to future events.

    Methods: Incident fatal and non-fatal CV events (hospitalizations due to unstable angina, myocardial infarction, coronary artery revascularization procedures, stroke, or CV death) were assessed in a prospective cohort of RA women followed since 2007 and without CV events at cohort entry. Read More

    Association of body mass index and waist circumference with severity of knee osteoarthritis.
    Acta Reumatol Port 2016 Jul-Sep;41(3):226-231
    Aim: The aim of the present study was to investigate the association of the body mass index (BMI) and waist circumference (WC) with the severity of radiographic severity of knee osteoarthritis (rKOA) Methods. A cross-sectional study had been applied during the research which included 150 patients diagnosed at the General Hospital in Užice and Health Center in Arilje (Serbia). The study included patients over the age of 50 diagnosed with OA according to The European League Against Rheumatism (EULAR) criteria. Read More

    Lymphocytopenia is associated with anti-Beta-2 glycoprotein-1 in patients with 220 systemic lupus erythematosus.
    Acta Reumatol Port 2016 Jul-Sep;41(3):220-225
    Background: Anti B2-Glicoprotein 1 (B2-GPI) is an antiphospholipid antibody that may be present in primary or secondary antiphospholipid syndrome (APS). Systemic Lupus erythematosus (SLE) is the main disease associated with secondary APS.

    Objective: To study the prevalence of anti B2-GPI in SLE patients. Read More

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