RESUMEN
Pain is the predominant symptom for people with inflammatory arthritis (IA) and osteoarthritis (OA) mandating the development of evidence-based recommendations for the health professional's approach to pain management. A multidisciplinary task force including professionals and patient representatives conducted a systematic literature review of systematic reviews to evaluate evidence regarding effects on pain of multiple treatment modalities. Overarching principles and recommendations regarding assessment and pain treatment were specified on the basis of reviewed evidence and expert opinion. From 2914 review studies initially identified, 186 met inclusion criteria. The task force emphasised the importance for the health professional to adopt a patient-centred framework within a biopsychosocial perspective, to have sufficient knowledge of IA and OA pathogenesis, and to be able to differentiate localised and generalised pain. Treatment is guided by scientific evidence and the assessment of patient needs, preferences and priorities; pain characteristics; previous and ongoing pain treatments; inflammation and joint damage; and psychological and other pain-related factors. Pain treatment options typically include education complemented by physical activity and exercise, orthotics, psychological and social interventions, sleep hygiene education, weight management, pharmacological and joint-specific treatment options, or interdisciplinary pain management. Effects on pain were most uniformly positive for physical activity and exercise interventions, and for psychological interventions. Effects on pain for educational interventions, orthotics, weight management and multidisciplinary treatment were shown for particular disease groups. Underpinned by available systematic reviews and meta-analyses, these recommendations enable health professionals to provide knowledgeable pain-management support for people with IA and OA.
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Artritis/terapia , Dolor Crónico/terapia , Manejo del Dolor/métodos , Artritis/complicaciones , Artritis Reumatoide/complicaciones , Artritis Reumatoide/terapia , Dolor Crónico/etiología , Medicina Basada en la Evidencia/métodos , Ejercicio Físico , Terapia por Ejercicio/métodos , Humanos , Aparatos Ortopédicos , Osteoartritis/complicaciones , Osteoartritis/terapia , Autocuidado/métodosRESUMEN
Fetal autoimmune atrioventricular block (AVB) is a rare but potentially life-threatening condition. It results from the passage of maternal anti-SSA/Ro or Anti SSB/La auto-antibodies into the fetal circulation, leading to inflammation and fibrosis of the AV node and often to irreversible damage. Besides AVB, these antibodies can also cause cardiomyopathies, but there is no evidence linking them to tachyarrhythmias. We present the case of a patient with significant risk factors for fetal AVB: a prior history of hydrops fetalis, high anti-SSA/Ro antibody levels and hypothyroidism. In this case, the use of dexamethasone and intravenous immunoglobulin may have contributed to reversing the first-degree atrioventricular block detected at 19 weeks of gestation. Additionally, at 21 weeks, the fetus developed a tachyarrhythmia that needed treatment with flecainide. Soon after the birth, the newborn underwent ECG Holter and Wolff-Parkinson-White Syndrome (WPWS) was diagnosed. To our knowledge, the coexistence of fetal AVB and WPWS has never been described.
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Anticuerpos Antinucleares , Bloqueo Atrioventricular , Taquicardia , Síndrome de Wolff-Parkinson-White , Humanos , Femenino , Embarazo , Anticuerpos Antinucleares/sangre , Anticuerpos Antinucleares/inmunología , Síndrome de Wolff-Parkinson-White/diagnóstico , Síndrome de Wolff-Parkinson-White/inmunología , Taquicardia/diagnóstico , Taquicardia/etiología , Bloqueo Atrioventricular/diagnóstico , Bloqueo Atrioventricular/inmunología , Bloqueo Atrioventricular/etiología , Adulto , Recién Nacido , Enfermedades Fetales/diagnóstico , Enfermedades Fetales/inmunología , Inmunoglobulinas Intravenosas/uso terapéuticoRESUMEN
OBJECTIVE: Pregnancy in women with lupus poses a higher risk of complications compared with the general population. The present study aimed to determine and describe the obstetric and neonatal outcomes of pregnant women with lupus. MATERIALS AND METHODS: We conducted an observational retrospective study of pregnant women with the diagnosis of lupus, who were selected and followed at the Maternal-Fetal Medicine Clinic of our institution between January 2013 and July 2018. We analyzed 59 pregnancies and 52 newborns, and collected data regarding sociodemographic features, the preconception period, pregnancy, childbirth, postpartum and the newborn. A descriptive analysis of the variables was performed. RESULTS: In 58% of the cases, the pregnancy was uneventful. We registered flares in 25% of the cases, preeclampsia in 3%, fetal growth restriction in 12%, gestational loss in 10%, preterm labor in 10%, postpartum complications in 20%, and small for gestational age newborns in 17% of the cases. CONCLUSIONS: Most pregnancies in women with lupus have favorable obstetric and neonatal outcomes. Prenatal counseling, adequate multidisciplinary surveillance, and optimized treatment of the disease are fundamental pillars for these good results.
OBJETIVO: A gravidez em mulheres com lúpus representa um risco maior de complicações em comparação com a população em geral. O presente estudo teve como objetivo determinar e descrever os resultados obstétricos e neonatais de gestantes com lúpus. MATERIAIS E MéTODOS: Realizamos um estudo retrospectivo observacional de gestantes com diagnóstico de lúpus, selecionadas e acompanhadas no Ambulatório de Medicina Materno-Fetal de nossa instituição entre janeiro de 2013 e julho de 2018. Analisamos 59 gestações e 52 recém-nascidos e coletamos dados referentes às características sociodemográficas, período pré-concepcional, gravidez, parto, pós-parto e nascimento. Foi realizada uma análise descritiva das variáveis. RESULTADOS: Em 58% dos casos, a gravidez transcorreu sem intercorrências. Registramos surtos em 25% dos casos, pré-eclâmpsia em 3%, restrição do crescimento fetal em 12%, perda gestacional em 10%, trabalho de parto prematuro em 10%, complicações pós-parto em 20% e recém-nascidos pequenos para a idade gestacional em 17% dos casos. CONCLUSõES: A maioria das gestações em mulheres com lúpus tem resultados obstétricos e neonatais favoráveis. Aconselhamento pré-natal, vigilância multidisciplinar adequada e tratamento otimizado da doença são pilares fundamentais para esses bons resultados.
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Complicaciones del Embarazo , Resultado del Embarazo , Embarazo , Femenino , Recién Nacido , Humanos , Resultado del Embarazo/epidemiología , Estudios Retrospectivos , Mujeres Embarazadas , Portugal/epidemiología , Complicaciones del Embarazo/epidemiología , Complicaciones del Embarazo/diagnóstico , Retardo del Crecimiento Fetal/epidemiologíaRESUMEN
The polymorphism of the tumor necrosis factor (TNF) promoter gene at position -308 and that of the lymphotoxin alpha (LTA) gene at position 252 have been implicated as genetic risk factors for systemic lupus erythematosus (SLE) in some populations. In a nested case-control study, we investigated the possible association of these polymorphisms with susceptibility to SLE and with phenotypic disease features in Portuguese Caucasian patients. TNF-308 G>A and LTA 252 A>G polymorphisms were determined by restriction fragment length polymorphism analysis in a cohort of 115 SLE patients and 152 unrelated healthy controls, and the magnitude of the association between genotypes and SLE diagnosis was calculated. For SLE patients, we also tested the association between disease characteristics and genotypes. No significant differences in genotype or allele frequencies could be identified between SLE cases and controls. Lupus nephritis (OR = 2.84; 95%CI 1.14-7.03, P = 0.02) and the presence of anti-Sm antibodies (OR = 3.11; 95%CI 1.08-8.94; P = 0.03) were significantly more prevalent among lupus patients possessing the TNF-308 A allele. The occurrence of nephritis was also higher in LTA 252 G allele carriers (OR = 2.90; 95%CI 1.12-7.54; P = 0.02). Our results do not support a major role of either the TNF-308 G>A or the LTA 252 A>G polymorphisms as genetic risk factors for SLE. Nevertheless, these polymorphisms appear to associate with the risk of renal lupus and distinct immunological features.
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Lupus Eritematoso Sistémico/genética , Linfotoxina-alfa/genética , Polimorfismo Genético , Regiones Promotoras Genéticas , Factor de Necrosis Tumoral alfa/genética , Población Blanca/genética , Adulto , Autoanticuerpos/sangre , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Femenino , Frecuencia de los Genes , Predisposición Genética a la Enfermedad , Humanos , Lupus Eritematoso Sistémico/sangre , Lupus Eritematoso Sistémico/etnología , Lupus Eritematoso Sistémico/inmunología , Nefritis Lúpica/genética , Nefritis Lúpica/inmunología , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Fenotipo , Reacción en Cadena de la Polimerasa , Polimorfismo de Longitud del Fragmento de Restricción , Portugal/epidemiología , Prevalencia , Medición de Riesgo , Factores de RiesgoRESUMEN
INTRODUCTION: Hand osteoarthritis (HOA) is a prevalent rheumatic disease that may cause significant disability. The Functional index for HOA (FIHOA) is a validated questionnaire to evaluate loss of function in patients with HOA. OBJECTIVE: To undertake a cross-cultural adaptation and validation of FIHOA into Portuguese. PATIENTS AND METHODS: First, the original French version of FIHOA had been forward-backward translated into Portuguese, according to the guidelines for cross-cultural adaptation. Secondly, patients with primary HOA were consecutively recruited in three Portuguese rheumatology outpatient clinics between May 2016 and April 2018. The final consensual Portuguese version of FIHOA was administered to 52 patients. A numerical rating scale (NRS - 0 to 100mm) for hand pain and for perceived hand dysfunction was also registered. Ten randomly selected patients were re-administered the same tools 5 to 15 days later. Internal consistency, test-retest reliability, internal construct validity and external validity related to dysfunction NRS were evaluated. RESULTS: Fifty-two patients were evaluated: all right-handed, 96% women, mean age of 63 (10) years and 8 (6) years of disease duration. Mean (SD) pain and dysfunction were 47 (25) and 46 (25), respectively, with 68% patients being symptomatic. Mean (SD) FIHOA was 7 (5). Cronbach's alpha for internal consistency was high and adequate (0.87) and corrected item-total correlation revealed adequate performance. For reliability, Spearman's rho coefficient was 0.88 and total intraclass correlation coefficient (ICC) between test and retest was 0.87, showing good reliability. Factor analysis revealed three factors accounting for 71% of the variance of the score, with the first one (including questions 1, 2, 3 and 10) being responsible for 47% of the variance. Spearman's rho between FIHOA and dysfunction NRS was 0.5, showing a moderate but significant correlation and moderate external validity. CONCLUSION: The Portuguese version of FIHOA is a consistent, reliable, and valid instrument to measure loss of function in HOA Portuguese patients.
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Articulaciones de la Mano , Osteoartritis , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis/diagnóstico , Dolor , Portugal , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVE: To update the recommendations for the treatment of rheumatoid arthritis (RA) with biological and targeted synthetic disease-modifying antirheumatic drugs (bDMARDs and tsDMARDs), endorsed by the Portuguese Society of Rheumatology (SPR). METHODS: These treatment recommendations were formulated by Portuguese rheumatologists taking into account previous recommendations, new literature evidence and consensus opinion. At a national meeting, in a virtual format, three of the ten previous recommendations were re-addressed and discussed after a more focused literature review. A first draft of the updated recommendations was elaborated by a team of SPR rheumatologists from the SPR rheumatoid arthritis study group, GEAR. The resulting document circulated among all SPR rheumatologists for discussion and input. The level of agreement with each of all the recommendations was anonymously voted online by all SPR rheumatologists. RESULTS: These recommendations cover general aspects such as shared decision, treatment objectives, systematic assessment of disease activity and burden and its registry in Reuma.pt. Consensus was also achieved regarding specific aspects such as initiation of bDMARDs and tsDMARDs, assessment of treatment response, switching and definition of persistent remission. CONCLUSION: These recommendations may be used for guidance of treatment with bDMARDs and tsDMARDs in patients with RA. As more evidence becomes available and more therapies are licensed, these recommendations will be updated.
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Antirreumáticos , Artritis Reumatoide , Reumatología , Antirreumáticos/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Consenso , Humanos , Portugal/epidemiologíaRESUMEN
Pain is a common feature of most rheumatic diseases and it is often the main reason for the patient to seek for a clinical appointment. Chronic pain has a major impact on patient's quality of life, being frequently associated with functional incapacity, sleep and mood disorders. This leads to absenteeism and heavy consumption of health resources, both representing huge burdens on national economy. Managing musculoskeletal pain is pivotal but can be challenging. The use of the available pharmaceutical armamentarium should be parsimonious. Opioids are strong analgesic drugs that mostly act through their agonist action on µ-receptors in the central nervous system. Opioid-related side effects are not negligible and are mediated through both central and peripheral opioid receptors. The use of opioids is well established in the treatment of oncologic pain but their role in the management of musculoskeletal pain is still controversial. Inflammatory rheumatic diseases, osteoarthritis, osteoporotic fractures, chronic low back pain and fibromyalgia represent diverse major rheumatic conditions that frequently lead to chronic pain. In order to standardize and optimize management of musculoskeletal chronic pain in these prevalent diseases, the Portuguese Rheumatology Society elaborated this position paper. The objectives were: a) to define the importance of pain assessment and classification; b) to guide patient selection, appropriate choice of opioids, their management, and raise awareness of their adverse effects; c) to review the existent data on possible indications of opioid therapy on rheumatic diseases.
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Analgésicos Opioides/uso terapéutico , Dolor Crónico/tratamiento farmacológico , Dolor Musculoesquelético/tratamiento farmacológico , Dimensión del Dolor/métodos , Enfermedades Reumáticas/tratamiento farmacológico , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/efectos adversos , Antiinflamatorios no Esteroideos/uso terapéutico , Dolor Crónico/diagnóstico , Esquema de Medicación , Reducción Gradual de Medicamentos/métodos , Fibromialgia/tratamiento farmacológico , Humanos , Dolor de la Región Lumbar/tratamiento farmacológico , Dolor Musculoesquelético/diagnóstico , Osteoartritis/tratamiento farmacológico , Fracturas Osteoporóticas/tratamiento farmacológico , Selección de Paciente , Portugal , Reumatología , Sociedades MédicasRESUMEN
INTRODUCTION: Concerns about the side effects and interactions of biologic drugs with reproduction and pregnancy have been always an issue between experts. The safety of these therapies during conception and/or pregnancy is not fully understood. The aim of this study was to assess the exposure to biologic drugs before and/or during conception/pregnancy and the risk of adverse pregnancy outcomes in women with rheumatic diseases. METHODS: We conducted a cohort study of pregnancies reported in women with immune-mediated rheumatic diseases registered at the Rheumatic Diseases Portuguese Registry (Reuma.pt) and exposed to biologic drugs. Data concerning fetal and maternal outcomes (live birth, spontaneous abortion, neonatal and intrauterine death, intrauterine growth restriction, premature delivery, congenital malformations, neonatal lupus, voluntary or medical interruption of pregnancy, disease flares and need for treatment with other drugs) was extracted. RESULTS: In total, 69 pregnancies from 56 females were analysed, the majority with the diagnosis of spondyloarthritis or rheumatoid arthritis. In almost half of the cases (n=32, 46.4%) the biologic was stopped for pregnancy planning, in 31 cases (44.9%) it was stopped when pregnancy was diagnosed and in 6 pregnancies (8.7%) biologic therapy was maintained, at least until the 2nd trimester. There were 76.8% of live births and 22% of spontaneous abortions. Congenital anomalies were reported in 2 newborns. CONCLUSIONS: In half cases, it was decided to stop biologic therapy in the family planning period. Using biologic disease-modifying anti-rheumatic drugs before and/or during pregnancy doesn't seem to affect the overall maternal and fetal outcomes. Pregnancy planning and treatment options should be discussed and a shared decision should be established between physician and patient.
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Antirreumáticos/efectos adversos , Terapia Biológica/efectos adversos , Complicaciones del Embarazo/tratamiento farmacológico , Resultado del Embarazo , Enfermedades Reumáticas/tratamiento farmacológico , Adulto , Antirreumáticos/uso terapéutico , Estudios de Cohortes , Femenino , Humanos , Atención Preconceptiva , Embarazo , Complicaciones del Embarazo/inmunología , Atención Prenatal , Estudios Retrospectivos , Enfermedades Reumáticas/inmunologíaRESUMEN
Abstract Objective Pregnancy in women with lupus poses a higher risk of complications compared with the general population. The present study aimed to determine and describe the obstetric and neonatal outcomes of pregnant women with lupus. Materials and Methods We conducted an observational retrospective study of pregnant women with the diagnosis of lupus, who were selected and followed at the Maternal-Fetal Medicine Clinic of our institution between January 2013 and July 2018. We analyzed 59 pregnancies and 52 newborns, and collected data regarding sociodemographic features, the preconception period, pregnancy, childbirth, postpartum and the newborn. A descriptive analysis of the variables was performed. Results In 58% of the cases, the pregnancy was uneventful. We registered flares in 25% of the cases, preeclampsia in 3%, fetal growth restriction in 12%, gestational loss in 10%, preterm labor in 10%, postpartum complications in 20%, and small for gestational age newborns in 17% of the cases. Conclusions Most pregnancies in women with lupus have favorable obstetric and neonatal outcomes. Prenatal counseling, adequate multidisciplinary surveillance, and optimized treatment of the disease are fundamental pillars for these good results.
Resumo Objetivo A gravidez em mulheres com lúpus representa um risco maior de complicações em comparação com a população em geral. O presente estudo teve como objetivo determinar e descrever os resultados obstétricos e neonatais de gestantes com lúpus. Materiais e Métodos Realizamos um estudo retrospectivo observacional de gestantes com diagnóstico de lúpus, selecionadas e acompanhadas no Ambulatório de Medicina Materno-Fetal de nossa instituição entre janeiro de 2013 e julho de 2018. Analisamos 59 gestações e 52 recém-nascidos e coletamos dados referentes às características sociodemográficas, período pré-concepcional, gravidez, parto, pós-parto e nascimento. Foi realizada uma análise descritiva das variáveis. Resultados Em 58% dos casos, a gravidez transcorreu sem intercorrências. Registramos surtos em 25% dos casos, pré-eclâmpsia em 3%, restrição do crescimento fetal em 12%, perda gestacional em 10%, trabalho de parto prematuro em 10%, complicações pós-parto em 20% e recém-nascidos pequenos para a idade gestacional em 17% dos casos. Conclusões A maioria das gestações em mulheres com lúpus tem resultados obstétricos e neonatais favoráveis. Aconselhamento pré-natal, vigilância multidisciplinar adequada e tratamento otimizado da doença são pilares fundamentais para esses bons resultados.
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Humanos , Femenino , Embarazo , Resultado del Embarazo , Lupus Eritematoso SistémicoRESUMEN
INTRODUCTION: Most clinical studies and basic research document viscosupplementation (VS) in terms of effectiveness and safety, but only a few highlight its molecular mechanisms of action. Besides, there is generally focus on hyaluronic acid (HA) as being the most relevant polysaccharide to reach the clinical endpoints, attributing its effect mainly to its unique viscoelastic properties, related to a high-molecular weight and gel formulation. Usually, studies do not approach the possible biological pathways where HA may interfere, and there is a lack of reports on other biocompatible polysaccharides that could be of use in VS. AIM: We briefly review the main proposed mechanisms of action of intra-articular hyaluronic acid (IA-HA) treatment and discuss its effectiveness focusing on the role of rheological and intrinsic structural molecular properties of polysaccharides in providing a therapeutic effect. METHODS: We conducted a literature search using PubMed database to find articles dealing with the mechanisms of action of IA-HA treatment and/or emphasizing how the structural properties of the polysaccharide used influenced the clinical outcomes. DISCUSSION/CONCLUSION: HA is involved in numerous biochemical interactions that may explain the clinical benefits of VS, most of them resulting from HA-cluster of differentiation 44 receptor interaction. There are other important aspects apart from the molecular size or the colloidal state of the IA-HA involved in VS efficiency that still need to be consolidated. Indeed, it seems that clinical response may be dependent on the intrinsic properties of the polysaccharide, regardless of being HA, rather than to rheology, posing some controversy to previous beliefs.
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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. Literature searches on these issues were performed and the search results were presented and discussed in a national meeting. Portuguese rheumatologists considered that affordability should be taken into consideration when initiating a biological drug, but other factors were equally important. In patients already on reference biological treatment, switch to a more affordable biosimilar is desirable, provided a set of conditions is rigorously met. Automatic substitution is not acceptable and current evidence is insufficient to support interchangeability. Extrapolation of clinical indications is endorsed by Portuguese rheumatologists, and the statements on safety, pharmacovigilance and traceability are in accordance with the previous position paper.
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Biosimilares Farmacéuticos/uso terapéutico , Enfermedades Reumáticas/tratamiento farmacológico , HumanosRESUMEN
OBJECTIVE: To update the recommendations for the treatment of Rheumatoid Arthritis (RA) with biological therapies, endorsed by the Portuguese Society of Rheumatology (SPR). METHODS: These treatment recommendations were formulated by Portuguese rheumatologists based on literature evidence and consensus opinion. At a national meeting the 10 recommendations were discussed and updated. The document resulting from this meeting circulated to all Portuguese rheumatologists, who anonymously voted online on the level of agreement with the recommendations. RESULTS: These recommendations cover general aspects as shared decision, prospective registry in Reuma.pt, assessment of activity and RA impact and treatment objective. Consensus was also achieved regarding specific aspects as initiation of biologic therapy, assessment of response, switching and definition of persistent remission. CONCLUSION: These recommendations may be used for guidance of treatment with biological therapies in patients with RA. As more evidence becomes available and more therapies are licensed, these recommendations will be updated.
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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. METHODS: The first Portuguese guidelines for the use of MTX in rheumatic diseases were published in 2009 and were integrated in the multinational 3E Initiative (Evidence Expertise Exchange) project. The Portuguese rheumatologists based on literature evidence and consensus opinion formulated 13 recommendations. At a national meeting, the recommendations included in this document were further discussed and updated. The document resulting from this meeting circulated to all Portuguese rheumatologists, who anonymously voted online on the level of agreement with the updated recommendations. RESULTS: Results presented in this article are mainly in accordance with previous guidelines, with some new information regarding hepatitis B infection during MTX treatment, pulmonary toxicity monitoring, hepatotoxicity management, association with hematologic neoplasms, combination therapy and tuberculosis screening during treatment. CONCLUSION: The present recommendations combine scientific evidence with expert opinion and attained desirable agreement among Portuguese rheumatologists. The regular update of these recommendations is essential in order to keep them a valid and useful tool in daily practice.
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Antirreumáticos/uso terapéutico , Metotrexato/uso terapéutico , Enfermedades Reumáticas/tratamiento farmacológico , Humanos , Portugal , Guías de Práctica Clínica como AsuntoRESUMEN
Resumo Enquadramento: As diferenças paradoxais identificadas entre a forma como as pessoas experienciam a dor, independente da sua intensidade, e o sofrimento a ela associado, relacionam-se com os sistemas de crenças e valores. Objetivos: Validar o Meaning in Suffering Test (MIST) para a população portuguesa e determinar as suas características psicométricas. Metodologia: Este estudo apresenta o processo de adaptação transcultural, realizado numa amostra de 187 pessoas com doença reumática músculo-esquelética (DRM), com recurso a questionário sociodemográfico, clínico e o MIST-P. Resultados: A amostra, maioritariamente do sexo feminino, tinha 49,9±12,1 anos. O MIST-P apresenta bons valores de fidelidade (alfa de Cronbach de 0,833). A análise fatorial determinou a organização dos 12 itens em 2 fatores: Sentido e respostas face ao sofrimento e Características subjetivas face ao sofrimento. A escala é estável no tempo (r = 0,844). Conclusão: O MIST-P é válido e fiável para a população portuguesa com DRM, tendo potencial para ser aplicado na investigação e na prática clínica de prevenção, controlo e integração do sofrimento inevitável.
Abstract Background: The paradoxical differences identified between the way people experience pain, regardless of its intensity, and the suffering associated with it relate to value and belief systems. Objective: To validate the Meaning in Suffering Test (MIST) for the Portuguese population and determine its psychometric characteristics. Methodology: This study presents the process of cross-cultural adaptation, carried out on a sample of 187 people with rheumatic and musculoskeletal diseases (RMDs), using a sociodemographic and clinical data questionnaire and the Teste de Sentido no Sofrimento (Portuguese version of the MIST - MIST-P). Results: The sample was mostly composed of women, with a mean age of 49.9±12.1 years. The MIST-P obtained a Cronbach's Alpha of 0.833, meaning a good reliability. The factorial analysis organized the 12 items into two factors: Meaning and responses to suffering and Subjective characteristics in the face of suffering. The scale shows stability over time (r = 0.844). Conclusion: The MIST-P is a valid and reliable tool for the Portuguese population with RMDs and can be applied in research and clinical practices aimed at the prevention, control, and integration of inevitable suffering.
Resumen Marco contextual: Las paradójicas diferencias identificadas entre la forma en que las personas experimentan el dolor, independientemente de su intensidad, y el sufrimiento asociado a este se relacionan con los sistemas de creencias y valores. Objetivos: Validar el Meaning in Suffering Test (MIST) para la población portuguesa y determinar sus características psicométricas. Metodología: Este estudio presenta el proceso de adaptación intercultural, llevado a cabo en una muestra de 187 personas con enfermedad reumática musculoesquelética (ERM), para lo cual se utilizó un cuestionario sociodemográfico, clínico y el MIST-P. Resultados: La muestra, mayoritariamente del sexo femenino, tenía 49,9±12,1 años. El MIST-P presenta buenos valores de fiabilidad (alfa de Cronbach de 0,833). El análisis factorial determinó la organización de los 12 ítems en 2 factores: Sentido y respuestas al sufrimiento y Características subjetivas ante el sufrimiento. La escala es estable a lo largo del tiempo (r = 0,844). Conclusión: El MIST-P es válido y fiable para la población portuguesa con ERM, y tiene el potencial de ser aplicado en la investigación y la práctica clínica para la prevención, el control y la integración del sufrimiento inevitable.
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OBJECTIVE: To develop recommendations for the treatment of psoriatic arthritis (PsA) 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. A draft of the recommendations was first circulated to all Portuguese rheumatologists and their suggestions were incorporated in the draft. At a national meeting the recommendations were discussed and all attending rheumatologists voted on the level of agreement for each recommendation. A second draft was again circulated before publication. RESULTS: A consensus was achieved regarding the initiation, assessment of response and switching biological therapies in patients with PsA. Specific recommendations were developed for several disease domains: peripheral arthritis, axial disease, enthesitis and dactylitis. CONCLUSION: These recommendations may be used for guidance in deciding which patients with PsA should be treated with biological therapies. They cover a rapidly evolving area of therapeutic intervention. As more evidence becomes available and more biological therapies are licensed, these recommendations will have to be updated.
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Artritis Psoriásica/terapia , Terapia Biológica/normas , HumanosRESUMEN
Interleukin-6 (IL-6) is a multifunctional cytokine with an important pathophysiological role in systemic lupus erythematosus (SLE). The polymorphism of the IL-6 gene promoter at position -174, which appears to influence the production of this cytokine, has been associated with susceptibility to some rheumatic diseases. The aim of this study is to investigate whether the IL-6 -174 G/C polymorphism associates with lupus susceptibility or affects disease characteristics in Portuguese patients with SLE. The association between -174 G/C and lupus diagnosis was studied in 115 adult SLE patients (95.7% females) and 152 healthy controls (94.7% females), all Caucasians. There were no significant differences in genotype or allele frequency between patients and controls. The -174 C/C genotype was independently associated with renal disease and the C allele with the presence of irreversible damage. The IL-6 gene promoter polymorphism at position -174 does not contribute to SLE susceptibility in Portuguese Caucasian patients but may predispose to specific manifestations of the disease.
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Interleucina-6/genética , Lupus Eritematoso Sistémico/genética , Lupus Eritematoso Sistémico/inmunología , Nefritis/complicaciones , Nefritis/genética , Polimorfismo Genético , Regiones Promotoras Genéticas , Edad de Inicio , Femenino , Humanos , Lupus Eritematoso Sistémico/complicaciones , Masculino , Portugal , Población BlancaRESUMEN
OBJECTIVES: Our goal was to test the performance of the new American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria for the classification of rheumatoid arthritis (RA) in a cohort of patients with very recent onset polyarthritis. PATIENTS: Untreated polyarthritis patients with less than 6 weeks of duration were enrolled. All patients were followed-up in order to establish a definitive diagnosis. RESULTS: Thirty-seven patients were included. During the follow up 57% of the patients evolved to RA. The median age of the RA-group patients was similar to the median age of the non-RA group [median (IQR) 47 (31-58.5) vs 43 (34-69) years, p=0.74]. At the initial visit the DAS 28 in the RA group was significantly higher than in the non-RA group, as well as the visual analogue scale (VAS), the HAQ and the number of swollen joints. Among the 21 RA patients, 43% presented RF and 28.6% presented anti-citrullinated protein antibody (ACPA) in the first visit. RF and ACPA were not detectable in any of the patients who did not evolve to RA. According to the new ACR/EULAR criteria, the mean total score of the RA group at baseline was significantly higher than the non-RA group [median (IQR) 6 (4.5-8) vs 4.5 (2.2-6), p=0.007]. CONCLUSION: In our cohort high DAS28, swollen joint count, VAS and HAQ and the presence of RF or ACPA were eventually associated with the evolution into RA. The new ACR/EULAR criteria for the classification of RA seem to perform well in very early RA.
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Artritis Reumatoide/clasificación , Artritis Reumatoide/etiología , Artritis/complicaciones , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Portugal , Estudios Prospectivos , Factores de TiempoRESUMEN
The authors present the revised version of the Portuguese Society of Rheumatology (SPR) guidelines for the treatment of rheumatoid arthritis (RA) with biological therapies. In these guidelines the criteria for introduction and maintenance of biological agents are discussed as well as the contraindications and procedures in the case of non-responders. Biological treatment should be considered in RA patients with a disease activity score 28 (DAS 28) superior to 3.2 despite treatment with 20mg/week of methotrexate (MTX) for at least 3 months or, if such treatment is not possible, after 6 months of other conventional disease modifying drug or combination therapy. A DAS 28 score between 2.6 and 3.2 with a significant functional or radiological deterioration under treatment with conventional regimens could also constitute an indication for biological treatment. The treatment goal should be remission or, if that is not achievable, at least a low disease activity, characterized by a DAS28 lower than 3.2, without significative functional or radiological worsening. The response criteria, at the end of the first 3 months of treatment, are a decrease of 0.6 in the DAS28 score. After 6 months of treatment response criteria is defined as a decrease of more than 1.2 in the DAS28 score. Non-responders, in accordance to the Rheumatologist's clinical opinion, should try a switch to another biological agent (tumour necrosis factor antagonist, abatacept, rituximab or tocilizumab).