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1.
Med. clín (Ed. impr.) ; 146(9): 413.e1-413.e14, mayo 2016. tab
Artigo em Espanhol | IBECS | ID: ibc-151654

RESUMO

El lupus eritematoso sistémico (LES) es una compleja enfermedad reumática multisistémica de origen autoinmune con una morbimortalidad importantes. Es una de las enfermedades autoinmunes más comunes, con una prevalencia estimada de 20-150/100.000 habitantes. El espectro clínico del LES es amplio y variable tanto en manifestaciones clínicas como en gravedad. Esto ha hecho que el Ministerio de Sanidad, Servicios Sociales e Igualdad haya promovido y financiado el desarrollo de una guía de práctica clínica (GPC) sobre el LES dentro del Programa de GPC en el Sistema Nacional de Salud que coordina GuiaSalud. Esta GPC pretende ser el instrumento de referencia en el Sistema Nacional de Salud para dar soporte a la gestión clínica integral de las personas con LES por parte de todos los profesionales sanitarios implicados, independientemente de la especialidad y el nivel asistencial, contribuyendo a homogeneizar y mejorar la calidad de las decisiones clínicas en nuestro entorno con el objetivo de mejorar los resultados de salud de las personas afectadas. En el presente artículo se presentan y discuten las recomendaciones formuladas en relación con el manejo general de la enfermedad, en concreto, el seguimiento clínico, el abordaje terapéutico general, los estilos de vida saludables, la fotoprotección y la formación para los pacientes. Recomendaciones basadas en la mejor evidencia científica disponible y en la discusión y consenso de grupos de expertos (AU)


Systemic lupus erythematosus (SLE) is a complex rheumatic multisystemic disease of autoimmune origin with significant potential morbidity and mortality. It is one of the most common autoimmune diseases with an estimated prevalence of 20-150 cases per 100,000 inhabitants. The clinical spectrum of SLE is wide and variable both in clinical manifestations and severity. This prompted the Spanish Ministry of Health, Social Services and Equality to promote and fund the development of a clinical practice guideline (CPG) for the clinical care of SLE patients within the Programme of CPG in the National Health System which coordinates GuiaSalud. This CPG is is intended as the reference tool in the Spanish National Health System in order to support the comprehensive clinical management of people with SLE by all health professionals involved, regardless of specialty and level of care, helping to standardize and improve the quality of clinical decisions in our context in order to improve the health outcomes of the people affected. The purpose of this document is to present and discuss the rationale of the recommendations on the general management of SLE, specifically, clinical follow-up, general therapeutic approach, healthy lifestyles, photoprotection, and training programmes for patients. These recommendationsare based on the best available scientific evidence, on discussion and the consensus of expert groups (AU)


Assuntos
Humanos , Masculino , Feminino , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/terapia , Guias de Prática Clínica como Assunto , Antimaláricos/uso terapêutico , Glucocorticoides/uso terapêutico , Prednisona/uso terapêutico , Retina , Sistemas Nacionais de Saúde , Monitoramento Epidemiológico/tendências , Prática Clínica Baseada em Evidências , Protetores Solares/uso terapêutico , Imunossupressores/uso terapêutico , Imunoglobulinas/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Remoção de Componentes Sanguíneos , Plasmaferese , Espanha/epidemiologia
2.
Med Clin (Barc) ; 146(9): 413.e1-14, 2016 May 06.
Artigo em Espanhol | MEDLINE | ID: mdl-26975887

RESUMO

Systemic lupus erythematosus (SLE) is a complex rheumatic multisystemic disease of autoimmune origin with significant potential morbidity and mortality. It is one of the most common autoimmune diseases with an estimated prevalence of 20-150 cases per 100,000 inhabitants. The clinical spectrum of SLE is wide and variable both in clinical manifestations and severity. This prompted the Spanish Ministry of Health, Social Services and Equality to promote and fund the development of a clinical practice guideline (CPG) for the clinical care of SLE patients within the Programme of CPG in the National Health System which coordinates GuiaSalud. This CPG is is intended as the reference tool in the Spanish National Health System in order to support the comprehensive clinical management of people with SLE by all health professionals involved, regardless of specialty and level of care, helping to standardize and improve the quality of clinical decisions in our context in order to improve the health outcomes of the people affected. The purpose of this document is to present and discuss the rationale of the recommendations on the general management of SLE, specifically, clinical follow-up, general therapeutic approach, healthy lifestyles, photoprotection, and training programmes for patients. These recommendations are based on the best available scientific evidence, on discussion and the consensus of expert groups.


Assuntos
Lúpus Eritematoso Sistêmico/terapia , Assistência ao Convalescente/métodos , Terapia Combinada , Progressão da Doença , Promoção da Saúde , Humanos , Imunossupressores/uso terapêutico , Programas Nacionais de Saúde , Espanha
3.
Semin Arthritis Rheum ; 41(6): 789-800, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22169458

RESUMO

OBJECTIVE: To investigate the incidence of clinical and immunological characteristics of a large cohort of Spanish patients with scleroderma (SSc) and identifying factors associated with particular organ manifestations assessed by a nationwide cross-sectional analysis. METHODS: We classified SSc patients in 4 subsets using a modification of LeRoy and Medsger classification that included: "prescleroderma" (pre-SSc), limited cutaneous SSc (lcSSc), diffuse cutaneous SSc (dcSSc), and SSc sine scleroderma (ssSSc). Fourteen Spanish centers participated in patient recruitment. On January 2008, the database included 916 consecutive Spanish SSc patients, 801 women (87.4%) and 115 men (12.6%), all of whom fulfilled the classification criteria proposed by LeRoy and Medsger. Epidemiological, clinical, and laboratory data were collected according to a standard protocol. Mean age at diagnosis was 51.2 ± 15.1 years and mean age at disease onset was 44.9.0 ± 15.8 years. lcSSc was the most frequent subset (61.8%) followed by dcSSc (26.5%), ssSSc (7.5%), and preSSc (4%) subsets. Gender ratios were as follows: dcSSc subset, 200 women and 43 men (4.7:1); lcSSc subset, 503 women and 63 men (ratio 7.9:1), and ssSSc subset, 62 women and 7 men (ratio 8.9:1). Digital ulcers, interstitial lung disease (ILD), musculoeskeletal and esophageal involvement, and scleroderma renal crisis were more frequent in dcSSc than lcSSc and ssSSc subsets. The incidence of pulmonary arterial hypertension assessed by echocardiography was similar in all subsets but mean estimated systolic pulmonary arterial pressure was higher in ssSSc than in lcSSc subset (47.3 ± 23.9 mm Hg vs 39.6 ± 19.2 mm Hg; P < 0.03). Cardiac involvement was identified more frequently in ssSSc than in dcSSc and lcSSc subsets (49.3% vs 32.5% and 31.1%, respectively; P = 0.015 and P = 0.004 for both comparisons). Acro-osteolysis (8.2% vs 2.4%, P = 0.049), calcinosis (19.8% vs 7.2%, P < 0.05), and sicca syndrome (37.5% vs 14.5%, P < 0.0001) were more frequent in lcSSc than in ssSSc subsets. The frequency of clinical manifestations related to the presence of anticentromere antibodies or antitopoisomerase I antibodies was very similar to that identified in patients categorized to lcSSc and dcSSc, respectively. However, in multivariate studies, the ranking of the variables according to their overall explanatory effect on the model showed that the contributory effect of the antibody status was not greater than that of the clinical categorization into lcSSc and dcSSc for the majority of disease manifestations, but, in important manifestations, as ILD, absence of anticentromere antibodies was an independent predictor factor. CONCLUSIONS: The classification of SSc into dcSSc, lcSSc, and ssSSc subsets is the one that most closely reflects the natural history of the disease, as they presented clear clinical differences. The immunological profile helps to define important visceral alteration as ILD. Finally, to improve early diagnosis of SSc, patients with preSSc should be considered both to trace the true evolution of the disease and to define which patients could benefit from therapeutic measures able to prevent the appearance of visceral involvements.


Assuntos
Escleroderma Sistêmico/diagnóstico , Escleroderma Sistêmico/epidemiologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Incidência , Doenças Pulmonares Intersticiais/complicações , Doenças Pulmonares Intersticiais/diagnóstico , Masculino , Pessoa de Meia-Idade , Fibrose Pulmonar/complicações , Fibrose Pulmonar/diagnóstico , Sistema de Registros , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/imunologia , Espanha/epidemiologia
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