RESUMO
OBJECTIVES: This study aimed to compare the clinical features, damage accrual, and survival of patients with familial and sporadic systemic lupus erythematosus (SLE). METHODS: A multi-ethnic, multinational Latin American SLE cohort was studied. Familial lupus was defined as patients with a first-degree SLE relative; these relatives were interviewed in person or by telephone. Clinical variables, disease activity, damage, and mortality were compared. Odds ratios (OR) and 95% confidence intervals (CI) were estimated. Hazard ratios (HR) were calculated using Cox proportional hazard adjusted for potential confounders for time to damage and mortality. RESULTS: A total of 66 (5.6%) patients had familial lupus, and 1110 (94.4%) had sporadic lupus. Both groups were predominantly female, of comparable age, and of similar ethnic distribution. Discoid lupus (OR = 1.97; 95% CI 1.08-3.60) and neurologic disorder (OR = 1.65; 95% CI 1.00-2.73) were significantly associated with familial SLE; pericarditis was negatively associated (OR = 0.35; 95% CI 0.14-0.87). The SLE Disease Activity Index and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) were similar in both groups, although the neuropsychiatric (45.4% vs. 33.5%; p = 0.04) and musculoskeletal (6.1% vs. 1.9%; p = 0.02) domains of the SDI were more frequent in familial lupus. They were not retained in the Cox models (by domains). Familial lupus was not significantly associated with damage accrual (HR = 0.69; 95% CI 0.30-1.55) or mortality (HR = 1.23; 95% CI 0.26-4.81). CONCLUSION: Familial SLE is not characterized by a more severe form of disease than sporadic lupus. We also observed that familial SLE has a higher frequency of discoid lupus and neurologic manifestations and a lower frequency of pericarditis.
Assuntos
Etnicidade , Lúpus Eritematoso Sistêmico/mortalidade , Adolescente , Adulto , Fatores Etários , Criança , Estudos de Coortes , Progressão da Doença , Feminino , Humanos , América Latina/epidemiologia , Lúpus Eritematoso Discoide/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pericardite/epidemiologia , Modelos de Riscos Proporcionais , Índice de Gravidade de Doença , Fatores Sexuais , Adulto JovemRESUMO
Este artigo aborda o tema das trabalhadoras negras no serviço público municipal de Porto Alegre, evidenciando suas histórias de vida e trajetórias profissionais no contexto do racismo estrutural, no período pós-1990. Para fins de investigação, a problematização do estudo partiu das trajetórias profissionais das trabalhadoras negras do município, que atuam nas áreas de educação, saúde e assistência social. A metodologia utilizada teve como aporte teórico-metodológico o materialismo histórico-dialético, de modo que foi realizada uma pesquisa exploratória e descritiva analítica, com aplicação da técnica de triangulação das informações. Ademais, se utilizou a história oral para a escuta das histórias e trajetórias no contexto do racismo estrutural, que afeta diretamente as mulheres negras ao longo de suas vidas, com questões relacionadas à classe, ao gênero e à raça. Foram entrevistadas seis mulheres negras servidoras públicas de Porto Alegre, militantes da luta antirracista. Também foi usada a técnica da análise documental sobre servidores(as) públicos(as) negros(as) na Prefeitura de Porto Alegre. Como resultado, constatou-se que, do total de servidores(as) públicos(as), 6,11% são servidoras negras. E, dentre as servidoras mulheres, 10,29% são negras. Verifica-se que os fios e as tramas do racismo estrutural, tendo como protagonistas as mulheres negras servidoras públicas de Porto Alegre, apontam o entrelaçamento entre classe, raça e gênero, demonstrando as formas de luta e resistência das mulheres negras em seu tempo sócio-histórico. Os resultados evidenciam a histórica desigualdade que afeta as mulheres negras trabalhadoras na sociedade capitalista/racista e o acirramento desta pós-golpe de 2016.O racismo estrutural se particulariza no trabalho, na realidade e na vivência das mulheres negras servidoras públicas da Prefeitura, onde se constatou que todas as servidoras negras pesquisadas sofreram e sofrem racismo em seus locais de trabalho, de diversas maneiras. Conclui-se que as lutas sociais vividas pelas trabalhadoras negras servidoras do município, especialmente no que diz respeito às formas de organização e resistência contra o racismo estrutural e o racismo institucional no serviço público municipal, fortalecem a resistência como um aspecto central para a luta pela emancipação humana, sendo esta permanente, em um processo histórico contínuo e no leito da luta
This article addresses the issue of black female workers in the municipal public service of Porto Alegre, highlighting their life stories and professional trajectories, in the context of structural racism, in the post-1990s period of the 20th century. For research purposes, the study's problematization came from the professional trajectories of black workers in the municipality, who work in the areas of education, health and social assistance. The methodology used had the historical-dialectical materialism as a theoretical-methodological contribution, where an exploratory and analytical descriptive research was carried out, with the application of the information triangulation technique. As well, oral history was used to listen to stories and trajectories in the context of structural racism, which directly affects black women throughout their lives, with issues related to class, gender and race. Six black women public servants from Porto Alegre, activists of the antiracist struggle, were interviewed. The document analysis technique was also used on black public servants in the Porto Alegre City Hall. As a result, it was found that of the total public servants in Porto Alegre, 6.11% are black servants. And among female servants, 10.29% are black. It is verified that the threads and plots of structural racism, having as protagonists the black women public servants of Porto Alegre, point out the intertwining between class, race and gender, demonstrating the forms of struggle and resistance of black women in their socio-historical time. The results show the historical inequality of black women workers in capitalist/racist society and the intensification of this post-2016 coup.Structural racism is particularized in the work, in the reality and experience of black women public servants of the city hall, where it was found that all black female servants surveyed suffered and do suffer racism in their workplaces in different ways. It is concluded that the social struggles experienced by black workers who serve the municipality, especially with regard to the forms of organization and resistance against structural racism and institutional racism in the municipal public service, strengthen resistance as a central aspect of the struggle for human emancipation, which is permanent and in a continuous historical process, and in the bed of struggle
RESUMO
To describe the baseline and follow up epidemiological/clinical characteristics of rheumatoid arthritis (RA) in a community-based cohort of the qom population. RA (ACR criteria) patients identified (n = 40) or not (n = 25) in the previous study were included. Baseline and follow-up visits (3, 6, and 12 months) were performed. Treatment adherence and modification, disability (Health Assessment Questionnaire Disability Index-HAQ-DI), and Disease Activity [DAS-28 (ESR)] were ascertained. At 12 months, complete and incomplete lost to follow-up patients were identified. The estimated RA prevalence was 3%. The patients' mean (SD) disease duration was 110.5 (17.9) and their median delay in diagnosis 30.4 (IQR 52.8) months; mean (SD) age and years of formal education were 39.8 (1.6) and 5.3 (SD 0.3); 58 (89.2%) were female, and 89.2% were seropositive. At baseline, their mean DAS-28 (ESR) was 4.8 (SD 0.9) with 67.7% having high disease activity and 32.3% moderate; 76.9% reported HAQ-DI ≥ 0.8. At 12 months, three patients have died; 13 (20.9%) were "completely" and 19 (30.6%) "incompletely" lost to follow-up. There were favorable changes over time for disease activity (p Ë 0.001), HAQ-DI (p Ë 0.001), and treatment modifications (p Ë 0.001) but no changes in treatment adherence (p = 0.260). The main cause of lost to follow-up was migration. This population has one of the highest RA prevalence rate reported. Patients had an aggressive and disabling disease, with poor adherence to treatment. Improvements of clinical parameters over time were observed.
Assuntos
Artrite Reumatoide/etnologia , Cooperação do Paciente/etnologia , Adolescente , Adulto , Argentina/etnologia , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/tratamento farmacológico , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Adulto JovemRESUMO
Introducción: la capilaroscopia es un método no invasivo que permite observar la microvasculatura en el área periungueal. Los resultados informados pueden ser altamente variables entre distintos observadores. A lo largo del tiempo surgieron métodos cuantitativos y semicuantitativos para mejorar la reproducibilidad. Objetivos: conocer el nivel de acuerdo intra e interobservador al informar los diferentes patrones capilaroscópicos en individuos con diferente nivel de entrenamiento. Materiales y métodos: estudio de corte transversal. Participaron médicos reumatólogos especialistas y en formación que habían realizado previamente un curso virtual de capacitación en capilaroscopia. Recibieron 40 imágenes capilaroscópicas proyectadas en una presentación de PowerPoint y debían responder a través de un cuestionario digital. Se evaluó la concordancia de respuestas intra e interobservador. Resultados: se encontró un alto nivel de concordancia global con un kappa 0,66 IC 95% (0,63-0,70) p<0,0000. También en otros grupos como reumatólogos en formación: kappa 0,65 IC 95% (0,60-0,71) p=0,0000, y médicos reumatólogos: kappa 0,67 IC 95% (0,62-0,72) p=0,0000. Conclusiones: el nivel de concordancia encontrado fue globalmente alto, independientemente del nivel de entrenamiento de los profesionales, y de ser o no reumatólogo. La concordancia fue superior cuando se comparó a quienes tenían más de 4 años de experiencia en la realización de videocapilaroscopia.
Introduction: videoapillaroscopy is a non-invasive method that allows the observation of the microvasculature in the periungual area. Reported results can be highly variable between different observers. Over time, quantitative and semi-quantitative methods emerged to improve reproducibility. Objetives: to know the level of intra and interobserver agreement when reporting the different capillaroscopic patterns in individuals with different levels of training. Materials and methods: cross section study. Specialist rheumatologists and those in training who had previously completed a virtual capillaroscopy training course participated. They received 40 capillaroscopic images projected in a PowerPoint presentation and had to issue their response through a digital questionnaire. Concordance of intra and interobserver responses was evaluated. Results: a high level of global agreement was found with a kappa 0.66 CI 95% (0.63-0.70) p<0.0000, also in other groups such as rheumatologists in training: kappa 0.65 CI 95% (0.60-0.71) p=0.0000, physicians rheumatologists: kappa 0.67 95% CI (0.62-0.72) p=0.0000. Conclusions: the level of agreement found was globally high, regardless of the level of training of the professionals, and whether or not they were a rheumatologist. Concordance was higher when compared to those who had more than 4 years of experience performing videocapillaroscopy.
Assuntos
Angioscopia Microscópica , Reumatologia , Esclerose MúltiplaRESUMO
This study assessed the overall and specific prevalence of the main rheumatic regional pain syndromes (RRPS) in four Latin-American indigenous groups. A Community Oriented Program for Control of Rheumatic Diseases (COPCORD) methodology-based census study was performed in 4240 adults (participation rate: 78.88 %) in four indigenous groups: Chontal (Oaxaca, Mexico, n = 124), Mixteco (Oaxaca, Mexico; n = 937), Maya-Yucateco (Yucatán, Mexico; n = 1523), and Qom (Rosario, Argentina; n = 1656). Subjects with musculoskeletal pain were identified using a cross-cultural, validated COPCORD questionnaire administered by bilingual personnel, and reviewed by general practitioners or rheumatologists using standardized case definitions for the 12 most frequent RRPS. The overall prevalence of RRPS was confirmed in 239 cases (5.64 %, 95 % CI: 4.98-6.37). The prevalence in each group was Chontal n = 19 (15.32 %, 95 % CI: 10.03-22.69); Maya-Yucateco n = 165 (10.83 %, 95 % CI: 9.37-12.49); Qom n = 48 (2.90 %, 95 % CI: 2.19-3.82); and Mixteco n = 7 (0.75 %, 95 % CI: 0.36-1.53). In the whole sample, the syndrome-specific prevalence was rotator cuff tendinopathy: 1.98 % (95 % CI: 1.60-2.45); lateral epicondylalgia: 0.83 % (95 % CI: 0.59-1.15); medial epicondylalgia: 0.73 % (95 % CI: 0.52-1.04); biceps tendinopathy: 0.71 % (95 % CI: 0.50-1.01); anserine syndrome: 0.64 % (95 % CI: 0.44-0.92); inferior heel pain: 0.61 % (95 % CI: 0.42-0.90); trochanteric syndrome: 0.49 % (95 % CI: 0.25-0.64); de Quervain's tendinopathy: 0.45 % (95 % CI: 0.29-0.70); trigger finger: 0.42 % (95 % CI: 0.27-0.67); carpal tunnel syndrome: 0.28 % (95 % CI: 0.16-0.49); Achilles tendinopathy (insertional): 0.12 % (95 % CI: 0.05-0.28); and Achilles tendinopathy (non-insertional): 0.07 % (95 % CI: 0.02-0.21). Leaving aside the comparison between Maya-Yucateco and Chontal groups (p = 0.18), we found significant differences (p < 0.001) in overall RRPS prevalence between the remaining pairs of indigenous groups. Syndrome-specific prevalences were also different between groups. Our findings support the hypothesis that overall RRPS prevalence and syndrome-specific prevalences are modulated by population-specific factors.
Assuntos
Indígenas Centro-Americanos , Indígenas Sul-Americanos , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/etnologia , Doenças Reumáticas/etnologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Censos , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Doenças Reumáticas/classificação , Inquéritos e Questionários , Adulto JovemRESUMO
This study aimed to estimate the prevalence of musculoskeletal disorders and rheumatic diseases among the indigenous Qom (Toba) population in the city of Rosario, Santa Fe, Argentina. An analytical cross-sectional study using methodology of the Community Oriented Program for the Control of Rheumatic Diseases (COPCORD) was performed. Subjects ≥18 years of age were interviewed by advanced students of medicine and nursing, bilingual translator-facilitators, and coordinators. Individuals with musculoskeletal pain (positive cases) were evaluated sequentially for 7 days by internists and rheumatologists for diagnosis and treatment. The study included 1656 individuals (77 % of the census population). Of these, 1020 (61.5 %) were female, with mean age of 35.3 (SD 13.9) years, and 1028 (62.0 %) were bilingual. The public health care system covers 87.1 % of the population. Musculoskeletal pain in the previous 7 days and/or at some time during their life was present in 890 subjects (53.7 %). Of those with pain in the last 7 days, 302 (64.1 %) subjects had an Health Assessment Questionnaire Disability Index (HAQ-DI) score ≥0.8. The most frequent pain sites were lumbar spine (19.3 %), knees (13.0 %), and hands (12.0 %). The prevalence of rheumatic diseases was as follows: mechanical back pain (20.1 %), rheumatic regional pain syndrome (2.9 %), osteoarthritis (4.0 %) rheumatoid arthritis (2.4 %), inflammatory back pain (0.2 %), systemic sclerosis (0.1 %), Sjögren syndrome (0.1 %), fibromyalgia (0.1 %), mixed connective tissue disease (0.06 %), and systemic lupus erythematosus (0.06 %). The prevalence of musculoskeletal disorders was 53.7 % and rheumatic diseases 29.6 %. Rheumatoid arthritis prevalence was 2.4 % using COPCORD methodology, one of the highest reported at present.