RESUMO
Abstract Spondyloarthritis (SpA) is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. Over some decades, nonsteroidal anti-inflammatory drugs (NSAIDs) have been the basis for the pharmacological treatment of patients with axial spondyloarthritis (axSpA). However, the emergence of the immunobiologic agents brought up the discussion about the role of NSAIDs in the management of these patients. The objective of this guideline is to provide recommendations for the use of NSAIDs for the treatment of axSpA. A panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis of randomized clinical trials for 15 predefined questions. The Grading of Recommendations, Assessment, Development and Evaluation methodology to assess the quality of evidence and formulate recommendations were used, and at least 70% agreement of the voting panel was needed. Fourteen recommendations for the use of NSAIDs in the treatment of patients with axSpA were elaborated. The purpose of these recommendations is to support clinicians' decision making, without taking out his/her autonomy when prescribing for an individual patient.(AU)
Assuntos
Humanos , Espondilite Anquilosante/tratamento farmacológico , Anti-Inflamatórios não Esteroides/uso terapêutico , Guias como Assunto/normas , Tomada de DecisõesRESUMO
Spondyloarthritis is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. The classification axial spondyloarthritis is adopted when the spine and/or the sacroiliac joints are predominantly involved. This version of recommendations replaces the previous guidelines published in May 2013.A systematic literature review was performed, and two hundred thirty-seven studies were selected and used to formulate 29 recommendations answering 15 clinical questions, which were divided into four sections: diagnosis, non-pharmacological therapy, conventional drug therapy and biological therapy. For each recommendation the level of evidence supporting (highest available), the strength grade according to Oxford, and the degree of expert agreement (inter-rater reliability) is informed.These guidelines bring evidence-based information on clinical management of axial SpA patients, including, diagnosis, treatment, and prognosis.
Assuntos
Terapia Biológica/normas , Reumatologia/normas , Sociedades Médicas/normas , Espondilartrite , Anti-Inflamatórios não Esteroides/uso terapêutico , Antirreumáticos/uso terapêutico , Terapia Biológica/métodos , Brasil , Exercício Físico , Terapia por Exercício , Glucocorticoides/uso terapêutico , Antígeno HLA-B27/sangue , Humanos , Imageamento por Ressonância Magnética , Educação de Pacientes como Assunto , Prognóstico , Reprodutibilidade dos Testes , Articulação Sacroilíaca , Sacroileíte/diagnóstico , Coluna Vertebral/diagnóstico por imagem , Espondilartrite/classificação , Espondilartrite/diagnóstico por imagem , Espondilartrite/terapiaRESUMO
Abstract Spondyloarthritis is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. The classification axial spondyloarthritis is adopted when the spine and/or the sacroiliac joints are predominantly involved. This version of recommendations replaces the previous guidelines published in May 2013. A systematic literature review was performed, and two hundred thirty-seven studies were selected and used to formulate 29 recommendations answering 15 clinical questions, which were divided into four sections: diagnosis, non-pharmacological therapy, conventional drug therapy and biological therapy. For each recommendation the level of evidence supporting (highest available), the strength grade according to Oxford, and the degree of expert agreement (inter-rater reliability) is informed. These guidelines bring evidence-based information on clinical management of axial SpA patients, including, diagnosis, treatment, and prognosis.
Assuntos
Humanos , Guias de Prática Clínica como Assunto , Espondilartrite/diagnóstico , Espondilartrite/terapia , Prognóstico , BrasilRESUMO
The Brazilian Societies of Rheumatology (SBR) and Dermatology (SBD), the Brazilian Federation of Gastroenterology (FBG) and the Brazilian Study Group on Inflammatory Bowel Disease (GEDIIB) gathered a group of their respective specialists on the topic of interest to discuss the most relevant issues regarding the clinical use of biosimilar medicines in Brazil. The main aim of that meeting was to prepare a document with recommendations to guide medical specialists and to help the national regulatory and policy-making agencies as concerns the authorization for marketing biosimilars used in autoimmune diseases, such as rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, Crohn's disease, juvenile idiopathic arthritis and ulcerative colitis. In addition to considerations on the typical differences between innovator medicines and biosimilars, the specialists established a set of seven recommendations on regulatory advances related to clinical studies, indication extrapolation, nomenclature, interchangeability, automatic substitution and pharmacovigilance.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Doenças Autoimunes/tratamento farmacológico , Medicamentos Biossimilares/uso terapêutico , Proteínas Recombinantes/uso terapêutico , Animais , Brasil , Gastroenteropatias/tratamento farmacológico , Humanos , Sociedades MédicasRESUMO
OBJECTIVE: Interactions between opioid use and hormonal function are documented in the literature. However, it is unclear if therapeutic intrathecal opioid therapy can induce hormonal changes, compared to oral opioid therapy. METHODS: The authors studied hormone and metabolic changes in 22 women (18-60 years) and 38 men (18-45 years) who were referred to a pain center. The patients were allocated to different treatment groups (based on assistant physicians' decision), as follows: 20 patients received oral morphine (60-120 mg/day); 20 patients, spinal morphine (0.2-10 mg/day); and 20 patients, nonopioid analgesic treatment. RESULTS: All three groups experienced substantial improvement in pain scores during the whole follow-up period. Significantly impaired libido, reduced potency, hot flashes, and menstrual cycle dysfunction occurred more often in both morphine groups than in the nonopioid group. Significantly low serum total testosterone levels were more prevalent in the spinal morphine group and the oral morphine group (58.3% and 70.0%, respectively) than in the control group (16.7%). Total cholesterol values above 200 mg/dL and higher ultrasensitive C-reactive protein levels were significantly more frequent in the morphine groups than in the controls. Total body bone mineral density was below normal in men receiving spinal morphine (P = 0.014). CONCLUSIONS: Hypogonadotrophic hypogonadism was more prevalent in the morphine groups and was correlated with clinical findings. Significant bone mass loss occurred in morphine users, even without hormone dysfunction when compared to nonopioid treatment. Growth hormone, thyroid stimulating hormone, adrenocorticotrophic hormones, and cardiovascular risk parameters were less compromised in morphine users.
Assuntos
Analgésicos Opioides/efeitos adversos , Dor Crônica/tratamento farmacológico , Sistema Hipotálamo-Hipofisário/efeitos dos fármacos , Morfina/efeitos adversos , Sistema Hipófise-Suprarrenal/efeitos dos fármacos , Administração Oral , Adolescente , Adulto , Analgésicos Opioides/administração & dosagem , Feminino , Humanos , Injeções Espinhais , Masculino , Pessoa de Meia-Idade , Morfina/administração & dosagem , Adulto JovemAssuntos
Humanos , Espondilite Anquilosante/complicações , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/patologia , Espondilite Anquilosante/prevenção & controle , Espondilite Anquilosante/reabilitação , Espondilite Anquilosante/terapia , Doenças da Coluna Vertebral , Doenças Ósseas , Doenças Musculoesqueléticas , Atividades Cotidianas , ReabilitaçãoRESUMO
OBJECTIVE: To compare skin folds in the dominant and nondominant halves of the body in a group (A) of 20 individuals with cerebral palsy and spastic hemiplegia and a group (B) of 30 normal volunteers. METHOD: Body mass, height and skin folds were measured, and the percentage of body fat was estimated by adipose tissue measurement and densitometry. The mean age in group (A) was 24.6 +/- 5.6 years (ranging from 16.1 to 38.1 years). The mean age in group (B) was 25.3 +/- 3.8 years (ranging from 19.0 to 34.11 years). RESULTS: Statistically significant differences were observed between the dominant and nondominant halves of the body for biceps, triceps, thoracic, suprailiac, thigh and midcalf skin folds in group A; the biceps, subscapular, midaxillary, suprailiac, abdominal, thigh and midcalf skin folds in group B; and the percentage fat obtained by adipose tissue measurement in both groups. Statistically significant differences were observed for the triceps skin fold when the dominant halves of the body in groups A and B were compared. Statistically significant differences were also observed for the biceps, triceps, thigh and midcalf skin folds as well as the adipose tissue measurements between the dominant and nondominant halves of the body in the two groups. The percentage fat as estimated by densitometry was significantly correlated with the adipose tissue measurement. CONCLUSION: There were statistically significant differences between the skin folds in the dominant and nondominant halves of the body, both in group A and in group B (greater in group A). There was a statistically significant correlation in the percentage fat as estimated by densitometry and as measured by adipose tissue in groups A and B.
Assuntos
Antropometria/métodos , Composição Corporal/fisiologia , Paralisia Cerebral/patologia , Lateralidade Funcional , Hemiplegia/patologia , Dobras Cutâneas , Absorciometria de Fóton , Tecido Adiposo/patologia , Adolescente , Adulto , Análise de Variância , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Estatísticas não Paramétricas , Imagem Corporal Total , Adulto JovemRESUMO
OBJECTIVE: To compare skin folds in the dominant and nondominant halves of the body in a group (A) of 20 individuals with cerebral palsy and spastic hemiplegia and a group (B) of 30 normal volunteers. METHOD: Body mass, height and skin folds were measured, and the percentage of body fat was estimated by adipose tissue measurement and densitometry. The mean age in group (A) was 24.6 ± 5.6 years (ranging from 16.1 to 38.1 years). The mean age in group (B) was 25.3 ± 3.8 years (ranging from 19.0 to 34.11 years). RESULTS: Statistically significant differences were observed between the dominant and nondominant halves of the body for biceps, triceps, thoracic, suprailiac, thigh and midcalf skin folds in group A; the biceps, subscapular, midaxillary, suprailiac, abdominal, thigh and midcalf skin folds in group B; and the percentage fat obtained by adipose tissue measurement in both groups. Statistically significant differences were observed for the triceps skin fold when the dominant halves of the body in groups A and B were compared. Statistically significant differences were also observed for the biceps, triceps, thigh and midcalf skin folds as well as the adipose tissue measurements between the dominant and nondominant halves of the body in the two groups. The percentage fat as estimated by densitometry was significantly correlated with the adipose tissue measurement. CONCLUSION: There were statistically significant differences between the skin folds in the dominant and nondominant halves of the body, both in group A and in group B (greater in group A). There was a statistically significant correlation in the percentage fat as estimated by densitometry and as measured by adipose tissue in groups A and B.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Adulto Jovem , Antropometria/métodos , Composição Corporal/fisiologia , Paralisia Cerebral/patologia , Lateralidade Funcional , Hemiplegia/patologia , Dobras Cutâneas , Absorciometria de Fóton , Análise de Variância , Tecido Adiposo/patologia , Estudos de Casos e Controles , Estatísticas não Paramétricas , Imagem Corporal Total , Adulto JovemRESUMO
A lombalgia é abordada em seus principais conceitos, classificações e etíologias, destacando os seus principais parâmetros epidemiológicos. São descritas as principais diferenças entre lombalgias e lombocíatalgías agudas e crônicas, para posteriormente relatar os principais fatores relacionados ao seu diagnóstico clínico, laboratoríal e imagenológico. As principais modalidades dos tratamentos farmacológicos, fisiátricos e cirúrgicos são descritos, procurando enfatizar suas indicações e possíveis resultados. Esta revisão foi realizada a partir das principais e mais recentes evídências científicas, já que foram baseadas em consensos, ensaios clínicos randomizados, revisões sistemáticas e metanálises.
Assuntos
Humanos , Dor LombarRESUMO
Objetivo: estabelecer diretrizes para o diagnóstico precoce, prevenção e tratamento da osteoporose. Métodos: representantes das diferentes especialidades que estudam e trabalham com os diferentes aspectos da osteoporose participaram deste consenso, no qual estabeleceram estas diretrizes baseados em uma revisão sistemática da literatura buscando evidências científicas consistentes. Os trabalhos foram selecionados pela sua metodologia, desenho, medidas adequadas e validade dos resultados contemplando procedimentos diagnósticos, preventivos e terapêuticos. Resultados: Após extensa discussão os participantes produziram um texto básico sujeito a correções posteriores, e revisões até a aprovação final
Assuntos
Guias como Assunto , OsteoporoseRESUMO
A lombalgia é abordada em seus principais conceitos, classificaçöes e estiologias, destacando os seus principais parâmetros epidemiológicos. Säo descritas as principais diferenças entre lombalgias e lombociatalgias agudas e crônicas, para posteriormente relatar os principais fatores relacionados ao seu diagnóstico clínico, laboratorial e imagenológico. As principais modalidades dos trratamentos farmacológicos, fisiátricos e cirúrgicos säo descritos, procurando enfatizar suas indicaçöes e possíveis resultados.(au)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Dor LombarRESUMO
Nesta revisäo, o autor inicialmente enumera, por ordem cronológica de introdução na prática clínica médica, os diversos métodos de imagem utilizados no diagnóstico e seguimento da osteoporose. Compara a precisão, acurácia, duração, segurança (dose de radiação), indicações, sensibilidade e especificidade dos diversos métodos de imagem descritos, com destaque para a radiografia simples, a densitometria óssea e a ultrasonometria óssea. Faz discussão das vantagens e desvantagens da densitometria óssea em comparação à ultra-sonometria óssea, ponderando que, apesar do recente grande desenvolvimento da ultra-sonometria óssea, a densitometria óssea pela técnica de raios-X de dupla energia (DEXA), continua sendo considerada a técnica padrão-ouro no diagnóstico e seguimento da osteoporose. Conclui pela necessidade de técnicas de imagem com medidas tridimensionais de volume, ao invés das atuais medidas bidimensionais de área, de padronização nacional ou regional de um banco de dados de referência composta por indivíduos controles normais brasileiros e por fim, de padronização mundial da tecnologia e conseqüentes medidas empregadas pelos diferentes fabricantes de equipamentos de densitometria e ultra-sonometria óssea.
Assuntos
Humanos , Diagnóstico por Imagem , Osteoporose/diagnóstico , Densidade Óssea , Densitometria , Sensibilidade e EspecificidadeRESUMO
Os autores fazem uma revisão da prevalência, distribuição sexual, racial e etária da espondilite anquilosante, bem como de sua história natural e de seu diagnóstico clínico, laboratorial (inclusive o HLA-B27) e imagenológico. Enumeram seus principais critérios de diagnóstico e classificação, além de citar seus principais índices de prognóstico, atividade de doença, gravidade de doença, incapacidade física e mortalidade. Dessa forma procuram descrever o impacto da morbidade da doença na qualidade de vida dos espondilíticos, além do impacto da mortalidade na qualidade de vida de seus portadores
Assuntos
Humanos , Morbidade , Qualidade de Vida , Espondilite AnquilosanteRESUMO
Os autores enumeram os pricipais índices de prognóstico, atividade de doença, gravidade de doença, incapacidade física e mortalidade da espondilite anquilosante. Fazem uma revisäo da prevalência, distribuiçäo sexual, racial e etária da espondilite anquilosante, bem como da sua história natural e do seu diagnóstico clínico,laboratorial (inclusive o HLA B27) e imagenológico. Dessa forma procuram descrever o impacto da morbidade da doença na qualidade de vida dos espondilíticos, além do impacto da mortalidade da doença na quantidade de vida dos seus portadores