RESUMO
Nuestro objetivo fue describir la frecuencia de úlceras digitales en una población de pacientes con Esclerosis Sistémica y comparar las características clínicas de los que desarrollaron úlceras de los que no lo hicieron. Se incluyeron en forma retrospectiva pacientes que cumplían criterios ACR para Esclerosis Sistémica. Se recolectaron datos demográficos, clínicos y serológicos de las historias clínicas. Se clasificó a los pacientes en dos grupos: un Grupo A con úlceras digitales y Grupo B aquellos pacientes sin antecedentes de úlceras digitales. Se compararon ambos grupos. Se estudiaron 60 pacientes con diagnóstico de Esclerosis Sistémica, 33% subtipo difuso, edad promedio al diagnóstico de 50,75 ± 14,75 años, el 15% (9 pacientes) eran de sexo masculino. La frecuencia de úlceras digitales fue de 33,33% (n=20). Los pacientes del grupo A eran más jóvenes al momento del diagnóstico (p=0,03) y tenían más tiempo de evolución de la enfermedad (pNS). En este grupo, fue más frecuente la forma difusa (p=0,002) y el fenómeno de Raynaud se inició a edades más precoces (p=0,006). Los pacientes del grupo A presentaron menor capacidad funcional, medida por HAQ score, y mayor frecuencia de patente tardía en la capilaroscopia, aunque no fue estadísticamente significativo. La totalidad de los pacientes de género masculino (n=9) tuvieron úlceras digitales (p <0,0001).Conclusión: El desarrollo de úlceras digitales en nuestro estudio se asoció a inicio más precoz de la enfermedad, a sexo masculino, a la forma difusa y a inicio más temprano de fenómeno de Raynaud.
The aim of this study was to describe digital ulcer frequency ina patient population with Systemic Sclerosis and to compare theclinical features of those who developed ulcers with those who didnot. Retrospectively, patients meeting ACR criteria for SystemicSclerosis were included. Demographic, clinical, and serologicalinformation was obtained from medical records. Patients wereclassified into two groups: Group A comprised patients with digitalulcers, while Group B included patients with no digital ulcers ontheir records. Findings for both groups were compared. We studied60 patients diagnosed with Systemic Sclerosis, 33% with diffusecutaneous subset, the mean age at the time of diagnosis was 50.75± 14.75 years, 15% (9 patients) were males. The frequency of digitalulcers was 33.33% (n=20). Group A patients were younger at thetime of diagnosis (p=0.03) and had longer time of evolution (pNS).The diffuse variant was more frequent in this group (p=0.002) andRaynauds phenomenon onset occurred at earlier ages (p=0.006).All male patients (n=9) entered into the study had digital ulcers (p<0.0001).Conclusions: In our study, development of digital ulcers wasassociated with an earlier onset of disease, males, diffuse subsetand an earlier onset of Raynauds phenomenon.
Assuntos
Humanos , Doença de Raynaud , Escleroderma Sistêmico , ÚlceraRESUMO
In our country, patients with congestive heart failure who are treated chronically with digoxin are usually advised by their physicians to stop taking the medication two days a week. This is probably aimed at decreasing digitalis toxicity. Based on digoxin pharmacokinetics we assumed that the drug plasmatic level should diminish by 40 to 50%, below the therapeutic concentration of 0.8 to 2 milligrams, after two days of suspension. The objectives of this study were: a) to analyze the reduction of the plasmatic concentration of digoxin after a two day interruption of treatment, b) to compare the plasmatic levels of the drug between patients who received continuous and discontinuous treatment. A prospective, randomized and simple blind trial was designed. A total of 36 patients with congestive heart failure and systolic dysfunction with atrial fibrillation or sinus rythm were included. Group 1 (19 patients) received continuous treatment and Group 2 (17 patients) took the drug from Monday to Friday. In the continuous treatment group there was no significant difference between the Monday (1.06 +/- 0.55 milligrams) and the Friday (1.1 +/- 0.57 milligrams) digoxin concentrations. In the discontinuous treatment group the Monday digoxin concentration (0.611 +/- 0.396 milligrams) was lower than the Friday one (1.04 +/- 0.58 milligrams). The difference was statistically significant with a p = 0.000002. In conclusion, the two days a week suspension schedule reduces the plasmatic concentration of digoxin to subtherapeutic levels while the continuous regime maintains stable concentrations within the therapeutic range. Adjusting the dose to the creatinine clearance, average concentrations of 1 milligram are obtained. These results suggest that digitalis intoxication could be prevented by adjusting the dose according to renal function rather than interrupting the treatment as it is usually done in our country.
