Percepção de pessoas com transtornos mentais acerca dos cuidados fisioterapêuticos: estudo qualitativo / Perception of people with mental disorders about physiotherapeutic care: qualitative study

INTRODUÇÃO: A inserção da fisioterapia nas equipes de cuidados à saúde mental tem se tornado cada vez mais necessária, devido à importância e efetividade em promover qualidade de vida em indivíduos com transtornos mentais. OBJETIVO: Compreender a percepção de pessoas com transtornos mentais acerca dos cuidados fisioterapêuticos. ESTRATÉGIA METODOLÓGICA: Estudo descritivo de abordagem qualitativa, realizado com nove indivíduos com transtornos mentais no Centro de Saúde Mental e Reabilitação Dr. Álvaro Rubin de Pinho, na cidade de Salvador, Bahia, Brasil, em julho/2021. Os dados foram coletados por meio do questionário sociodemográfico e entrevista semiestruturada, que posteriormente foram transcritas e analisadas conforme análise de conteúdo de Bardin. RESULTADOS: Mediante a exploração dos conteúdos, emergiram três categorias: "O olhar dos indivíduos com transtornos mentais acerca da fisioterapia"; "Atenção e o cuidado no sofrimento psíquico" e "Efetividade fisioterapêutica na saúde mental". Evidenciou-se que os indivíduos percebem que a fisioterapia proporcionou melhora nos aspectos físicos, mentais e sociais, além de atuar como coadjuvante no tratamento. CONSIDERAÇÕES FINAIS: A assistência fisioterapêutica contribui na promoção da saúde, reabilitação psicossocial e melhora da qualidade de vida nos indivíduos com transtornos mentais.

INTRODUCTION: The insertion of physiotherapy in mental health care teams has become increasingly necessary due to its importance and effectiveness in promoting life quality in individuals who suffer with mental disorders. OBJECTIVE: To understand the perception of people from mental disorders about physiotherapeutic care. METHODOLOGICAL STRATEGY: Descriptive study of qualitative approach, carried out with nine individuals with mental disorders at the Dr. Alvaro Rubin de Pinho Mental Health and Rehabilitation Center, in the city of Salvador, Bahia, Brazil, in July/2021. The collected material was acquired through a sociodemographic questionnaire and a semi-structured interview, which was later transcribed and analyzed according to Bardin's content analysis. RESULTS: Through the exploration of the contents, three categories emerged: "Perspectives of individuals with mental disorders about physiotherapy"; "Attention and care in psychic suffering", and "Physiotherapeutic effectiveness in mental health". It became evident that the individuals realize that physiotherapy provided improvement in the physical, mental, and social aspects, besides acting as an adjunct in the treatment. FINAL CONSIDERATIONS: Physiotherapeutic assistance contributes to health promotion, psychosocial rehabilitation, and improvement of the quality of life of individuals with mental disorders.

Genetic Polymorphisms in Patients With Systemic Lupus Erythematosus and Jaccoud Arthropathy: A Pilot Study.

INTRODUCTION: Jaccoud arthropathy (JA) is a nonerosive and deforming arthropathy experienced frequently by patients with systemic lupus erythematosus (SLE). Although genetic polymorphisms are associated with SLE development, the association between genetic polymorphisms and JA has not been studied to date. The main objective of this study was to evaluate an association between HLA, STAT4, IRF5, and BLK polymorphisms and the presence of JA in Brazilian individuals with SLE. METHODS: Patients were selected from a cohort of individuals with SLE followed at 2 rheumatology reference centers in Salvador, Bahia, Brazil. The JA diagnosis was based on clinical and radiological criteria. The participants were genotyped for rs9271100, rs7574865, rs10488631, and rs13277113 polymorphisms in the HLA, STAT4, IRF5, and BLK genes, respectively, using real-time polymerase chain reaction. The presence of JA was correlated with allele frequencies, and clinical and laboratory data. RESULTS: One hundred forty-four individuals with SLE (38 with JA and 106 with SLE without JA) were studied. The mean age of the patients was 45 ± 12 years; the majority were women and had brown skin. Patients with JA had a longer disease duration than patients without JA. Serositis and neuropsychiatric manifestations were more frequent in the JA population. The A allele of rs13277113 in the BLK gene was associated with the presence of JA. CONCLUSIONS: The rs13277113 polymorphism in the BLK gene was found to be a possible genetic risk for JA development. However, further studies in larger populations should be performed to confirm this finding.

The Influence of Hand Dominance on the Degree of Deformities in Patients With Systemic Lupus Erythematosus and Jaccoud Arthropathy.

BACKGROUND/OBJECTIVE: Joint deformities in Jaccoud arthropathy (JA), associated with systemic lupus erythematosus (SLE), can lead to a reduction in articular function and an impaired quality of life. There is controversy in the literature as to whether hand dominance contributes to deformities observed in rheumatoid arthritis and other forms of rheumatism. The purpose of this study was to assess whether hand dominance has any influence on the degree of deformity or joint range of motion in patients with JA associated with SLE. METHODS: This was a pilot cross-sectional study of 22 female patients (mean age, 46.18 ± 12.61 years) with both SLE and JA. Each patient's hand grip and hand and wrist joint range of motion were assessed by the same examiner. The Wilcoxon test was used to compare the median values of the angles and muscular strength found between the sides. RESULTS: All the study participants were right-side dominant. The median muscle strength of the right and left hands was 13.25 kilogram-force (KgF) (range, 7.00-18.00 KgF) and 10.50 KgF (range, 7.50-17.25 KgF), respectively. Both the fingers of the right and left hands had a median ulnar drift of 10.00°; however, their ranges differed (right, 4.50° to 20.00°; left: 0.00° to 15.50°). No statistically significant differences were found in the extension angulation of the proximal interphalangeal joints or the flexion of the distal interphalangeal joints of the second to fifth fingers, between the dominant and nondominant hands. CONCLUSIONS: Hand dominance does not seem to influence the degree of JA deformities in patients with SLE.

Humanização na formação acadêmica: percepção do estudante de fisioterapia / Humanization in academic education: perception of physiotherapy student

INTRODUÇÃO: A humanização se destaca como um importante aliado no processo de assistência a saúde. Sendo assim, buscando sua efetivação, torna-se fundamental que suas propostas estejam inseridas desde o processo de graduação do fisioterapeuta. OBJETIVOS: conhecer a percepção de estudantes ingressantes e concluintes do curso de fisioterapia sobre a humanização na formação do fisioterapeuta e identificar sua inserção no decorrer do curso de fisioterapia. ESTRATÉGIA METODOLÓGICA: estudo descritivo, comparativo e de abordagem qualitativa. Participaram da pesquisa quatorze estudantes de fisioterapia, sendo dez destes acadêmicos concluintes (9º semestre) e quatro ingressantes do curso (1º semestre), que responderam a uma entrevista semi-estruturada que abordou questões referentes a humanização e sua importância. Os dados foram analisados sob a perspectiva de Bardin, e todos os entrevistados assinaram o Termo de Consentimento Livre e Esclarecido (TCLE) antes de realizar a entrevista, com a aprovação do Comitê de ética, CAAE: 73475617.1.0000.5628. RESULTADOS: após transcrição das entrevistas e análise rigorosa do discurso, todo o material coletado foi categorizado como: 1. "As diferentes definições da humanização"; 2. "Porta de entrada para o conhecer da temática humanização", com subcategoria "Vivência da humanização na formação acadêmica" e 3. "A importância da assistência humanizada". CONSIDERAÇÕES FINAIS: os acadêmicos concluintes do curso de fisioterapia, ainda que apresentem dificuldade de aprofundamento teórico e prático, demonstraram melhor compreensão sobre a temática humanização, quando comparados com os estudantes ingressantes, pois estes possuem pouca familiaridade com a temática.

INTRODUCTION: Humanization stands out as an important ally in the healthcare process. Thus, seeking its effectiveness, it is fundamental that its proposals are inserted since the graduation process of the physiotherapist. OBJECTIVE: to know the perception of incoming and finishing students of the physiotherapy course on humanization in the training of the physiotherapist and to identify their insertion during the course of physical therapy. METHODOLOGICAL STRATEGY: a descriptive, comparative and qualitative approach. Fourteen physiotherapy students participated in the study, of which ten (9th semester) and four undergraduate students (1 st semester) completed a semi-structured interview that addressed issues related to humanization and its importance. The data were analysed from the perspective of Bardin, and all the interviewees signed the Free and Informed Consent Form before conducting the interview, with the approval of the Ethics Committee, CAAE: 73475617.1.0000.5628. RESULTS: after transcription of the interviews and rigorous discourse analysis, all collected material was categorized as: 1. "The different definitions of humanization"; 2. "Entrance door to learn about the theme of humanization", with subcategory "Living humanization in academic formation" and 3. "The importance of humanizing assistance". FINAL CONSIDERATIONS: the final students of the physiotherapy course, although they present difficulties of theoretical and practical deepening, demonstrated a better understanding about the humanization theme, when compared to the incoming students, since they have little familiarity with the subject.

Sonographic Findings of Hands and Wrists in Systemic Lupus Erythematosus Patients With Jaccoud Arthropathy.

INTRODUCTION: Jaccoud arthropathy (JA) is a deforming nonerosive arthropathy, characterized by the presence of "reversible" joint deformity. The study aims at describing the main musculoskeletal ultrasound (US) findings of a series of systemic lupus erythematosus (SLE) patients with JA. METHODS: Consecutive patients diagnosed as having JA and SLE were included in the study. All patients underwent a whole clinical evaluation and US of the hands and wrists. The US scan evaluated the presence of synovial hypertrophy, tenosynovitis, and bone erosions. RESULTS: Thirty-nine of 40 patients were female. The US examination was performed on 560 joints of the hands and wrists. At least 1 change was observed in the US examination of 20 patients (50.0%), but there was not a statistically significant association with disease activity (P = 0.33). Nineteen patients (47.5%) had synovial hypertrophy, 9 (22.5%) had tenosynovitis, and 7 (17.5%) had both. Isolated small bone erosions were identified in 2 patients (5.0%). CONCLUSIONS: Ultrasound examination is a reliable and noninvasive imaging method for the evaluation of joint involvement in SLE. Half of the patients with JA have ultrasonographic signs of joint inflammation, and these abnormalities may be found even in the absence of disease activity.

Severe Jaccoud's arthropathy in systemic lupus erythematosus.

Jaccoud's arthropathy (JA) is a clinical situation nowadays present mostly in systemic lupus erythematosus (SLE). It is characterized by the presence of joint deformities such as "swan neck," ulnar deviation and "Z-thumb" resembling rheumatoid arthritis (RA) but that are passively correctable and without bone erosion on plain radiographs. From our cohort of SLE patients with JA, we selected a subgroup with a more severe form of this arthropathy and looked at their clinical and laboratory profile as well as studied the magnetic resonance imaging (MRI) findings or ultrasound (US) obtained from the hand with most evident deformities. Seven SLE patients with a severe form of JA were identified. All seven patients have "swan neck," ulnar deviation and "Z-thumb" deformities. Two out of seven had "mutilans-type JA" and four had fixed deformities in the metacarpophalangeal (MCP) joints. The MRI of the hand with more evident deformity clinically performed in six cases and US performed in one case showed mild synovitis in five and moderate synovitis in two patients, mild flexor tenosynovitis in six and severe tenosynovitis in one. Only two small bone erosions were observed in the second and third MCP joints of one patient with moderate synovitis. Severe JA compromises the functional capacity of the joints and imposes the risk of misdiagnosis of RA. With the improvement of the survival rate of SLE and the lack of specific prophylactic or therapeutical measures for JA, it is reasonable to assume that more and more cases of severe JA are going to be identified.

Achados de imagem das alterações musculoesqueléticas associadas ao lúpus eritematoso sistêmico / Imaging findings of musculoskeletal disorders associated with systemic lupus erythematosus

O lúpus eritematoso sistêmico é uma doença autoimune que envolve múltiplos sistemas orgânicos. O acometimento musculoesquelético é uma das manifestações mais comuns da doença, com envolvimento ósseo, articular, muscular, tendíneo e ligamentar, tanto primário como relacionado ao tratamento instituído. Neste artigo revisamos e ilustramos as alterações articulares e complicações musculoesqueléticas mais comuns relacionadas a esta doença.

Systemic lupus erythematosus is an autoimmune disease involving multiple organ systems. Musculoskeletal involvement is one of the most frequent presentations of the disease, affecting bones, joints, muscles, tendons and ligaments, either as a primary manifestation or secondary to the treatment of the disease. In the present article, the authors review and illustrate the joint disorders and the most common musculoskeletal abnormalities seen in this disorder.

Valvular heart disease in systemic lupus erythematosus and Jaccoud's arthropathy.

Jaccoud's arthropathy (JA) was initially described as a secondary complication to rheumatic fever (RF). However, most recently described cases are associated with systemic lupus erythematosus (SLE). At least in RF, this articular complication has been observed to occur in association with valvular heart disease. The aim of this work is to investigate the presence of valvulopathy in patients with SLE and JA, when compared to lupus patients without such complication. Patients with diagnosis of SLE based on the American College of Rheumatology criteria were enrolled in the study and divided into two groups: with or without JA and evaluated by transthoracic echocardiography. A total of 113 patients with SLE (25 with JA and 88 without JA) were assessed, of which 108 were females and five were males. Echocardiographic changes were found in 24 patients (21.2%) out of the entire population, including valvulopathy in 17 cases (15%), pulmonary hypertension in 7 cases (6.2%) and pericardial effusion in 2 cases (1.8%). In general, echocardiographic changes were more frequently seen in the JA group in comparison with the control group (p = 0.04). Additionally, in the JA group, valvulopathy was found in nine cases (36%) against eight cases (9%) in the control group (p = 0.001). This study reveals for the first time the association between the presence of valvular heart disease and JA in SLE patients, suggesting that the presence of JA may be a marker of such complication. Additional studies are required for clarification of the mechanisms involved in both complications.

Magnetic resonance imaging of Jaccoud's arthropathy in systemic lupus erythematosus.

OBJECTIVE: To perform a detailed magnetic resonance imaging (MRI) analysis of the hands of patients with Jaccoud's arthropathy (JA) secondary to systemic lupus erythematosus (SLE). METHODS: The hand with more expressive deformities compatible with JA from a group of SLE patients was examined by 1.5-T MRI. The protocol included coronal, sagittal, and axial turbo-spin-echo images before and after the administration of contrast medium. The presence of synovitis, edema, erosion, cysts, and tenosynovitis in the carpometacarpal, metacarpophalangeal, and proximal interphalangeal joints were scored based on a modified Outcome Measures in Rheumatology recommendations. RESULTS: Twenty SLE patients, (19 women and one man) with median age of 44.7 years (range: 20-76 years), median disease duration of 14.7 years (range: 5-26 years), and median arthritis duration of 13.7 years (range: 4-26 years) were studied. Of the 300 joints evaluated, 202 (67.3%) had some degree of synovitis. Sixteen out of 300 examined joints (5.3%) small areas of erosion were seen in 10 out of the 20 patients (50%). Subchondral bone edema was found in eight out of the 20 (40%) patients or a total of 18 joints (6%). A total of 200 compartments tendons were evaluated, and changes were found in 77 (38.5%) of them. In four out of the 20 patients, the MRI revealed bone cysts. CONCLUSIONS: The MRI seems to be a non-invasive diagnostic tool in patients with JA secondary to SLE, and may contribute to understanding the mechanism involved in the development of this deformity.

Profile of autoantibodies in Jaccoud's arthropathy.

OBJECTIVE: To compare the frequency of different autoantibodies in a group of patients with Jaccoud's arthropathy (JA) secondary to systemic lupus erythematosus (SLE) with those without JA. METHODS: A group of SLE patients with JA was compared with another group of SLE patients without this complication, matched by age and gender, regarding the presence of autoantibodies. Antibodies to cyclical citrullinated peptides (anti-CCP) and to mutated citrullinated vimentin (anti-MCV) as well as anti-SSA/Ro, anti-SSB/La, anti-Sm and anti-RNP and anticardiolipin (aCL) antibodies were searched by ELISA, using commercial kits. Rheumatoid factor was determined by nephelometry and antinuclear and anti-dsDNA antibodies by IIF. RESULTS: Forty-eight individuals were included in the study, being 24 patients with JA and 24 without JA, matched by gender and age. The frequency of anti-CCP antibodies in the whole population was 12.5% (6 cases), with no difference between the 2 groups. Anti-MCV antibodies were detected in 10.4% (5 cases), being found only in those with JA (p=0.05). There was no association between the presence of JA and aCL, anti-Sm, anti-RNP and anti-SSB/La antibodies. On the other hand, a statistically significant association between the presence of anti-dsDNA antibodies and JA was observed (p=0.04) as well as a marginal association with a decrease in serum levels of C3 (p=0.06). CONCLUSION: In the present study, there was an association between the presence of JA and anti-dsDNA antibodies, and anti-MCV antibodies were found only in those SLE patients with JA. Whether these antibodies have an etiopathogenic role in JA is entirely unknown.

Jaccoud arthropathy in systemic lupus erythematosus: analysis of clinical characteristics and review of the literature.

Jaccoud arthropathy (JA) was initially described in patients with rheumatic fever and later in several other rheumatologic conditions, particularly systemic lupus erythematosus (SLE). In patients with the latter disorder, a prevalence of about 5% has been observed. We conducted the current study to describe a series of patients with SLE with JA, followed at the Hospital Santa Izabel, Salvador, Brazil, during the year 2006. We reviewed the literature on JA, with emphasis on the histologic, clinical, radiologic, and therapeutic aspects of the condition. Twenty-one patients with JA were identified, corresponding to a prevalence of 3.47% in the population of 606 patients with the diagnosis of SLE attended in our service. Twenty patients were women, and the mean age was 40.2 +/- 8.8 years (range, 24-55 yr). The most frequently found joint deformities were swan neck and thumb subluxation, both identified in 14 patients. Ulnar deviation was seen in 8, boutonniere deformity in 3, and hallux valgus in 2 patients. We found no difference in the clinical or laboratory features in SLE patients with or without JA. The patients with JA presented a trend toward a lower quality of life compared with the patients with SLE without JA, but without statistical significance.