ABSTRACT
OBJECTIVE: To elaborate recommendations to the vaccination of patients with rheumatoid arthritis (RA) in Brazil. METHOD: Literature review and opinion of expert members of the Brazilian Society of Rheumatology Committee of Rheumatoid Arthritis and of an invited pediatric rheumatologist. RESULTS AND CONCLUSIONS: The following 12 recommendations were established: 1) Before starting disease-modifying anti-rheumatic drugs, the vaccine card should be reviewed and updated; 2) Vaccines against seasonal influenza and against H1N1 are indicated annually for patients with RA; 3) The pneumococcal vaccine should be indicated for all patients with RA; 4) The vaccine against varicella should be indicated for patients with RA and a negative or dubious history for that disease; 5) The HPV vaccine should be considered for adolescent and young females with RA; 6) The meningococcal vaccine is indicated for patients with RA only in the presence of asplenia or complement deficiency; 7) Asplenic adults with RA should be immunized against Haemophilus influenzae type B; 8) An additional BCG vaccine is not indicated for patients diagnosed with RA; 9) Hepatitis B vaccine is indicated for patients with RA who are negative for antibodies against HBsAg; the combined hepatitis A and B vaccine should be considered; 10) Patients with RA and at high risk for tetanus, who received rituximab in the preceding 24 weeks, should undergo passive immunization with tetanus immunoglobulin in case of exposure; 11) The YF vaccine is contraindicated to patients with RA on immunosuppressive drugs; 12) The above described recommendations should be reviewed over the course of RA.
Subject(s)
Arthritis, Rheumatoid , Vaccination , HumansABSTRACT
OBJETIVO: Elaborar recomendações para a vacinação em pacientes com artrite reumatoide (AR) no Brasil. MÉTODO: Revisão da literatura e opinião de especialistas membros da Comissão de AR da Sociedade Brasileira de Reumatologia e um pediatra reumatologista. RESULTADOS E CONCLUSÕES: Foram estabelecidas 12 recomendações: 1) Antes de iniciar drogas modificadoras do curso de doença, deve-se revisar e atualizar o cartão vacinal; 2) As vacinas contra influenza sazonal e contra H1N1 estão indicadas anualmente para pacientes portadores de AR; 3) A vacina antipneumocócica deve ser indicada para todos os pacientes; 4) A vacina contra varicela deve ser indicada para pacientes com história negativa ou duvidosa de infecção prévia por varicela; 5) A vacina contra HPV deve ser considerada em adolescentes e mulheres jovens; 6) A vacina antimeningocócica é indicada para pacientes portadores de AR apenas em casos de asplenia ou deficiência de complemento; 7) Existe orientação de imunização contra o Haemophilus influenzae tipo B de pacientes adultos asplênicos; 8) Não há indicação de uma vacina adicional contra BCG em pacientes com AR; 9) A vacina contra hepatite B é indicada para pacientes com anticorpos contra HBsAg negativos; considerar a vacina contra hepatite A em combinação com a hepatite B; 10) Pacientes com grande risco de contrair tétano que receberam rituximabe nas últimas 24 semanas devem utilizar imunização passiva com imunoglobulina antitetânica; 11) A vacina contra febre amarela é contraindicada nos pacientes com AR em uso de imunossupressores; 12) As recomendações acima descritas devem ser revisadas ao longo da evolução da AR.
OBJECTIVE: To elaborate recommendations to the vaccination of patients with rheumatoid arthritis (RA) in Brazil. METHOD: Literature review and opinion of expert members of the Brazilian Society of Rheumatology Committee of Rheumatoid Arthritis and of an invited pediatric rheumatologist. RESULTS AND CONCLUSIONS: The following 12 recommendations were established: 1) Before starting disease-modifying anti-rheumatic drugs, the vaccine card should be reviewed and updated; 2) Vaccines against seasonal influenza and against H1N1 are indicated annually for patients with RA; 3) The pneumococcal vaccine should be indicated for all patients with RA; 4) The vaccine against varicella should be indicated for patients with RA and a negative or dubious history for that disease; 5) The HPV vaccine should be considered for adolescent and young females with RA; 6) The meningococcal vaccine is indicated for patients with RA only in the presence of asplenia or complement deficiency; 7) Asplenic adults with RA should be immunized against Haemophilus influenzae type B; 8) An additional BCG vaccine is not indicated for patients diagnosed with RA; 9) Hepatitis B vaccine is indicated for patients with RA who are negative for antibodies against HBsAg; the combined hepatitis A and B vaccine should be considered; 10) Patients with RA and at high risk for tetanus, who received rituximab in the preceding 24 weeks, should undergo passive immunization with tetanus immunoglobulin in case of exposure; 11) The YF vaccine is contraindicated to patients with RA on immunosuppressive drugs; 12) The above described recommendations should be reviewed over the course of RA.
Subject(s)
Humans , Arthritis, Rheumatoid , VaccinationABSTRACT
OBJECTIVES: Rheumatologist assessment as early as possible is considered essential for patients with inflammatory joint disease. In our Very Early Arthritis Clinic (VEAC), a substantial proportion of initially included and followed patients later stop attendance in the clinic. We questioned attending (AP) and non-attending patients (NAP) regarding current health status and satisfaction with care as well as reasons for discontinuation and current care received by NAP. METHODS: VEAC patients first seen between 1996 and 2003 were included. Assessment included the RADAI, HAQ, and visual analogue scales for pain, disease activity, fatigue, satisfaction with current health care. Current (DMARD) treatment was recorded. RESULTS: Among AP, 87% had rheumatoid arthritis (RA) and 13% non-RA. Of NAP, 37% had RA, 23% non-RA and 40% no more rheumatic disease. Satisfaction with health care concerning rheumatic disease was better in AP than NAP. Likewise, most outcome parameters were better in AP. Substantially more RA patients in the AP than NAP group received DMARDs. Apart from the disappearance of arthritis, logistic reasons were given most frequently for discontinuation of attendance. Less than 10% of NAP indicated dissatisfaction with medical care. CONCLUSIONS: We found advantages in both disease activity measures and satisfaction with health care for patients receiving continuous care in a highly specialised Rheumatology clinic. Furthermore, different DMARD usage in RA in AP and NAP may indicate significant deficits in treatment quality outside specialist care. Logistic issues associated with access to continuous Rheumatology care for early arthritis patients need improvement.
Subject(s)
Arthritis, Rheumatoid/therapy , Arthritis/therapy , Continuity of Patient Care , Health Behavior , Health Knowledge, Attitudes, Practice , Outpatient Clinics, Hospital , Patient Compliance , Adult , Aged , Arthritis/diagnosis , Arthritis, Rheumatoid/diagnosis , Austria , Chi-Square Distribution , Continuity of Patient Care/statistics & numerical data , Disability Evaluation , Female , Health Services Accessibility , Health Status , Health Status Indicators , Humans , Male , Middle Aged , Outpatient Clinics, Hospital/statistics & numerical data , Patient Compliance/statistics & numerical data , Patient Satisfaction , Predictive Value of Tests , Remission Induction , Risk Assessment , Risk Factors , Severity of Illness Index , Time Factors , Treatment OutcomeSubject(s)
Humans , Male , Female , Fibromyalgia , Hypothyroidism , Pain , Surveys and Questionnaires , Rheumatic Diseases , ThyrotropinABSTRACT
A sinovite hipertrófica familiar é uma condição rara, de origem familiar, que deve ser lembrada no diagnóstico das artrites da infância. Os autores apresentam o caso de um menino de 7 anos, portador de deformidades dos artelhos em flexão e múltiplos derrames articulares indolores acometendo grandes articulações, desde o nascimento e sem sintomas sistêmicos. O paciente possui uma prima com quadro semelhante.
Subject(s)
Humans , Male , Child , Diagnosis, Differential , Joint Diseases , SynovitisABSTRACT
Perda visual permanente, resultante de inflamação ocular recidivante, ocorre freqüentemente em pacientes com doença de Behçet, apesar de tratamento imunossupressor crônico e intensivo. Os autores relatam o caso de um paciente masculino, com 35 anos de idade, apresentando uveíte posterior, crônica e bilateral, refratária ao tratamento com corticosteróides e imunossupressores. O tratamento com infliximabe mostrou um efeito benéfico na uveíte desse paciente.
Subject(s)
Humans , Male , Adult , Behcet Syndrome , Tumor Necrosis Factor-alpha , Uveitis, Posterior/therapy , Uveitis, PosteriorABSTRACT
Histoplasma capsulatum, a ground fungus, can infect humans, normally in endemic areas; the resulting disease can be asymptomatic or it can have a benign development, but in rare cases it can develop into a serious clinical condition and can even be fatal. Its most characteristic initial location is in the lungs, resembling tuberculosis, often accompanied by mediastinitis and an exuberant fibrotic response. The spread of this infection can be caused by the concomitance of another illness that alters the immunological balance. Sometimes such an association is not clear. Therefore, disseminated histoplasmosis is defined as a clinical condition where the fungus is present in more than one location. Common variable immunodeficiency is characterized by a generalized failure in the synthesis of antibodies, leading the affected individuals to present recurrent infections, especially those caused by encapsulated bacteria, most often involving the respiratory tract. We studied a serious case of disseminated histoplasmosis, accompanied by common variable immunodeficiency, observed at the Infirmary of the department of Medical Practice of the Federal University at Paraná Hospital das Clínicas.
Subject(s)
Common Variable Immunodeficiency/complications , Histoplasmosis/complications , Adult , Common Variable Immunodeficiency/diagnosis , Fatal Outcome , Histoplasma/isolation & purification , Histoplasmosis/diagnosis , Humans , MaleABSTRACT
Histoplasma capsulatum, a ground fungus, can infect humans, normally in endemic areas; the resulting disease can be asymptomatic or it can have a benign development, but in rare cases it can develop into a serious clinical condition and can even be fatal. Its most characteristic initial location is in the lungs, resembling tuberculosis, often accompanied by mediastinitis and an exuberant fibrotic response. The spread of this infection can be caused by the concomitance of another illness that alters the immunological balance. Sometimes such an association is not clear. Therefore, disseminated histoplasmosis is defined as a clinical condition where the fungus is present in more than one location. Common variable immunodeficiency is characterized by a generalized failure in the synthesis of antibodies, leading the affected individuals to present recurrent infections, especially those caused by encapsulated bacteria, most often involving the respiratory tract. We studied a serious case of disseminated histoplasmosis, accompanied by common variable immunodeficiency, observed at the Infirmary of the department of Medical Practice of the Federal University at Paraná Hospital das Clínicas
Subject(s)
Humans , Male , Adult , Common Variable Immunodeficiency , Histoplasma , Histoplasmosis , Common Variable Immunodeficiency , Fatal Outcome , HistoplasmosisABSTRACT
O intuito de tal estudo é observar a prevalência de alteraçöes oculares numa populaçäo de pacientes portadores de HIV e avaliar a efetividade do exame oftalmoscópico sob midríase realizado por estudantes de medicina na detecçäo do envolvimento fundoscópico nestes pacientes e observar a ocorrência de sintomas oculares e alteraçöes fundoscópicas nestes pacientes. Foram avaliados pacientes portadores do HIV, em tratamento no Sistema Unico de Saúde em Curitiba, entre julho de 1996 e abril de 1997. As variáveis observadas foram: idade, sexo, presença de atividade laboral, existencia de sintomas oculares e as medicaçöes anti-retrovirais sistêmicas utilizadas. Um total de 120 pacientes foram submetidos a oftalmoscopia monocular direta por näo especialistas que, ao considerarem os pacientes como tendo alteraçöes fundoscópicas, encaminhavam-nos ao oftalmologista para realizaçäo de oftalmoscopia binocular indireta. Correlacionando-se o exame fundoscópico näo especializado, os sintomas e a avaliaçäo especializada dos pacientes, pode-se afirmar que o clínico pode desempenhar um papel importante no diagnóstico precoce de lesöes córioretinianas na Aids. Concluiu-se que os sintomas oculares mais frequentes foram visäo embaçada e moscas volantes e as alteraçöes oculares mais comuns, manchas algodonosas e turvaçäo de meios.(au)
Subject(s)
Humans , Male , Female , Adult , Retinal Diseases/diagnosis , Retinal Diseases/etiology , HIV , Acquired Immunodeficiency Syndrome/complicationsABSTRACT
A dissecçäo intra-coronariana durante a angioplastia está relacionada com complicaçöes isquêmicas agudas. Este trabalho analisa os resultados imediatos do implante de stent coronariano em angioplastias complicadas por dissecçäo. De outubro de 1994 a junho de 1996, 50 pacientes foram submetidos ao implante de stent em 51 lesöes em situaçöes nas quais a angioplastia com baläo obteve resultado inadequado. Trinta e seis pacientes (72 por cento) eram do sexo masculino e a idade média foi 58 anso (30-92). Cinco tipos de stents foram utilizados: 25 (50 por cento) eram do tipo Wiktor, 13 (26 por cento) Gianturco-Roubin, 8 (16 por cento) Wallstent, 5 (10 por cento) Palmaz-Schatz e 2 (4 por cento) Buchler-Levini. Das dissecçöes observadas, 4 (9 por cento) eram do tipo A, 14 (32 por cento) do tipo B, 4 (9 por cento) do tipo C, 12 (28 por cento) do tipo D, 5 (12 por cento) do tipo E E 3 (7 por cento) do tipo F. A média dos graus de obstruçäo pré-angioplastia foi de 83 por cento (70-100 por cento) e a média pós-angioplastia com stent foi 1 por cento (0-20 por cento). O índice de sucesso na colocaçäo dos stents foi de 100 por cento, índice de sucesso do procedimento foi de 95 por cento. Näo houve cirurgia de emergência nem infarto agudo do miocárdio. Houve 3 (6 por cento) óbitos hospitalares näo relacionados com o procedimento. Os resultados mostraram elevado percentual de sucesso nos procedimentos realizados e impoëm a utilizaçäo de stent em casos de dissecçäo pós-angioplastia com baläo