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1.
Z Rheumatol ; 80(Suppl 1): 13-32, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33398466

RESUMO

BACKGROUND: Rheumatic diseases frequently present with pulmonary involvement. All anatomic structures of the lungs can be affected. Interstitial lung diseases are characterized by a system of patterns evident in high-resolution computed tomography (HR-CT) scanning of the lungs. The HR-CT pattern can differ between rheumatic diseases. OBJECTIVE: Systematic description of all variants and patterns of pulmonary involvement in rheumatic diseases. MATERIAL AND METHODS: Narrative review based on the current literature on the topic from the perspective of rheumatology, pulmonary diseases and radiology. RESULTS: Pulmonary involvement is frequent and prognostically relevant. The summary of pulmonary involvement reveals a high variability of affected anatomical structures as well as patterns of interstitial diseases for inflammatory rheumatic diseases. A synopsis of the main diagnostic findings is provided. CONCLUSION: Every rheumatic disease presented here can be associated with pulmonary involvement. Therefore, a systematic diagnostic evaluation is mandatory at the first diagnosis as well as during follow-up. Apart from clinical findings and lung function HR-CT of the lungs is decisive for the diagnostics.


Assuntos
Doenças do Colágeno , Doenças Pulmonares Intersticiais , Doenças Reumáticas , Humanos , Pulmão/diagnóstico por imagem , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/etiologia , Doenças Reumáticas/complicações , Doenças Reumáticas/diagnóstico por imagem
2.
Curr Rheumatol Rep ; 23(1): 5, 2021 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-33403528

RESUMO

PURPOSE OF REVIEW: Severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) emerged in December 2019, rapidly reaching global pandemic proportions. Coronavirus disease 2019 (COVID-19) has presented unique challenges to the rheumatology community. It is known that many individuals with rheumatic disease are at increased risk of severe disease from other infections, sparking a similar fear for COVID-19. In addition, medications routinely used in rheumatology practice are being trialled as treatments, with the potential for drug shortages for rheumatology patients. RECENT FINDINGS: Underlying comorbidities and active disease are associated with worse COVID-19 outcomes in patients with rheumatic disease. Tocilizumab and hydroxychloroquine have not proven to be effective treatments in the management of COVID-19. Telehealth has become an essential tool for the rheumatology community to monitor patients during the pandemic. In this article, we summarise the available COVID-19 evidence that is of relevance to the rheumatology community. We discuss the risk of contracting COVID-19 in individuals with rheumatic disease, along with presenting features and clinical outcomes. We provide an overview of the treatments for COVID-19 which have significance for rheumatology. We highlight published recommendations which can guide our management of rheumatic disease populations during this pandemic. Finally, we discuss the challenges in delivering effective care virtually and present methods and tools which could be adapted for use.


Assuntos
/complicações , Doenças Reumáticas/complicações , Doenças Reumáticas/terapia , Reumatologia , Antirreumáticos/uso terapêutico , Humanos , Telemedicina
4.
RMD Open ; 7(1)2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33510041

RESUMO

OBJECTIVES: To evaluate risk factors associated with unfavourable outcomes: emergency care, hospitalisation, admission to intensive care unit (ICU), mechanical ventilation and death in patients with immune-mediated rheumatic disease (IMRD) and COVID-19. METHODS: Analysis of the first 8 weeks of observational multicentre prospective cohort study (ReumaCoV Brasil register). Patients with IMRD and COVID-19 according to the Ministry of Health criteria were classified as eligible for the study. RESULTS: 334 participants were enrolled, a majority of them women, with a median age of 45 years; systemic lupus erythematosus (32.9%) was the most frequent IMRD. Emergency care was required in 160 patients, 33.0% were hospitalised, 15.0% were admitted to the ICU and 10.5% underwent mechanical ventilation; 28 patients (8.4%) died. In the multivariate adjustment model for emergency care, diabetes (prevalence ratio, PR 1.38; 95% CI 1.11 to 1.73; p=0.004), kidney disease (PR 1.36; 95% CI 1.05 to 1.77; p=0.020), oral glucocorticoids (GC) (PR 1.49; 95% CI 1.21 to 1.85; p<0.001) and pulse therapy with methylprednisolone (PR 1.38; 95% CI 1.14 to 1.67; p=0.001) remained significant; for hospitalisation, age >50 years (PR 1.89; 95% CI 1.26 to 2.85; p=0.002), no use of tumour necrosis factor inhibitor (TNFi) (PR 2.51;95% CI 1.16 to 5.45; p=0.004) and methylprednisolone pulse therapy (PR 2.50; 95% CI 1.59 to 3.92; p<0.001); for ICU admission, oral GC (PR 2.24; 95% CI 1.36 to 3.71; p<0.001) and pulse therapy with methylprednisolone (PR 1.65; 95% CI 1.00 to 2.68; p<0.043); the two variables associated with death were pulse therapy with methylprednisolone or cyclophosphamide (PR 2.86; 95% CI 1.59 to 5.14; p<0.018). CONCLUSIONS: Age >50 years and immunosuppression with GC and cyclophosphamide were associated with unfavourable outcomes of COVID-19. Treatment with TNFi may have been protective, perhaps leading to the COVID-19 inflammatory process.


Assuntos
/imunologia , Imunossupressão/efeitos adversos , Sistema de Registros , Doenças Reumáticas/complicações , Adulto , Brasil/epidemiologia , Cuidados Críticos/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Respiração Artificial/estatística & dados numéricos , Doenças Reumáticas/imunologia
5.
RMD Open ; 7(1)2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33479021

RESUMO

INTRODUCTION: Whether patients with inflammatory rheumatic and musculoskeletal diseases (RMD) are at higher risk to develop severe courses of COVID-19 has not been fully elucidated. Aim of this analysis was to describe patients with RMD according to their COVID-19 severity and to identify risk factors for hospitalisation. METHODS: Patients with RMD with PCR confirmed SARS-CoV-2 infection reported to the German COVID-19 registry from 30 March to 1 November 2020 were evaluated. Multivariable logistic regression was used to estimate ORs for hospitalisation due to COVID-19. RESULTS: Data from 468 patients with RMD with SARS-CoV-2 infection were reported. Most frequent diagnosis was rheumatoid arthritis, RA (48%). 29% of the patients were hospitalised, 5.5% needed ventilation. 19 patients died. Multivariable analysis showed that age >65 years (OR 2.24; 95% CI 1.12 to 4.47), but even more>75 years (OR 3.94; 95% CI 1.86 to 8.32), cardiovascular disease (CVD; OR 3.36; 95% CI 1.5 to 7.55), interstitial lung disease/chronic obstructive pulmonary disease (ILD/COPD) (OR 2.79; 95% CI 1.2 to 6.49), chronic kidney disease (OR 2.96; 95% CI 1.16 to 7.5), moderate/high RMD disease activity (OR 1.96; 95% CI 1.02 to 3.76) and treatment with glucocorticoids (GCs) in dosages >5 mg/day (OR 3.67; 95% CI 1.49 to 9.05) were associated with higher odds of hospitalisation. Spondyloarthritis patients showed a smaller risk of hospitalisation compared with RA (OR 0.46; 95% CI 0.23 to 0.91). CONCLUSION: Age was a major risk factor for hospitalisation as well as comorbidities such as CVD, ILD/COPD, chronic kidney disease and current or prior treatment with GCs. Moderate to high RMD disease activity was also an independent risk factor for hospitalisation, underlining the importance of continuing adequate RMD treatment during the pandemic.


Assuntos
/diagnóstico , Glucocorticoides/efeitos adversos , Doenças Musculoesqueléticas/complicações , Doenças Reumáticas/complicações , /genética , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Artrite Reumatoide/complicações , Artrite Reumatoide/tratamento farmacológico , /terapia , Estudos de Casos e Controles , Comorbidade , Feminino , Alemanha/epidemiologia , Glucocorticoides/uso terapêutico , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/tratamento farmacológico , Sistema de Registros , Respiração Artificial/métodos , Estudos Retrospectivos , Doenças Reumáticas/tratamento farmacológico , Fatores de Risco
6.
Autoimmun Rev ; 20(2): 102742, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33333235

RESUMO

Autoimmune rheumatic diseases (ARD) are characterized by systemic manifestations and multiple organ involvement, including the lung. Interstitial Lung Disease (ILD) is a cardinal manifestation of lung involvement in patients with ARD and is associated with significant morbidity and mortality. Corticosteroids and immunosuppressive drugs are used as first -line treatment. Targeted therapies, such as biological disease modifying antirheumatic drugs (DMARDS) and anti- fibrotic agents are new treatment options. In this review we discuss the role of targeted therapies in patients with ILD secondary to ARD.


Assuntos
Antirreumáticos , Doenças Autoimunes , Doenças Pulmonares Intersticiais , Doenças Reumáticas , Antirreumáticos/uso terapêutico , Doenças Autoimunes/complicações , Doenças Autoimunes/tratamento farmacológico , Humanos , Imunossupressores/uso terapêutico , Doenças Pulmonares Intersticiais/complicações , Doenças Pulmonares Intersticiais/tratamento farmacológico , Doenças Reumáticas/complicações , Doenças Reumáticas/tratamento farmacológico
8.
Med Clin North Am ; 105(1): 175-186, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33246517

RESUMO

Unintentional weight loss is a common clinical problem with a broad differential diagnosis that is clinically important because of the associated risks of morbidity and mortality. Community-dwelling adults are often diagnosed with malignancy, nonmalignant gastrointestinal disorders, and psychiatric disorders as the cause of unintentional weight loss, whereas institutionalized older adults are diagnosed most often with psychiatric disorders. Up to a quarter of patients do not have a diagnosis after comprehensive workup, and close follow-up is warranted. Treatment involves management of underlying causes.


Assuntos
Perda de Peso , Envelhecimento/fisiologia , Doenças Cardiovasculares/complicações , Doença Crônica , Doenças Transmissíveis/complicações , Diagnóstico Diferencial , Suplementos Nutricionais , Doenças do Sistema Endócrino/complicações , Gastroenteropatias/complicações , Humanos , Anamnese , Transtornos Mentais/complicações , Neoplasias/complicações , Exame Físico , Doenças Respiratórias/complicações , Doenças Reumáticas/complicações , Perda de Peso/fisiologia
9.
Rheumatology (Oxford) ; 59(12): 3645-3656, 2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-33313932

RESUMO

OBJECTIVES: Pleuroparenchymal fibroelastosis (PPFE) is characterized by predominantly upper lobe pleural and subjacent parenchymal fibrosis; PPFE features were described in patients with rheumatic autoimmune diseases (RAID). A systematic literature review was performed to investigate the prevalence, prognosis and potential association of PPFE with previous immunosuppression in RAID. METHODS: EMBASE, Web of Science and PubMed databases were questioned from inception to 1 September 2019. Articles published in English and addressing PPFE in patients with RAID were selected. RESULTS: Twenty out of 794 papers were selected with a total of 76 cases of RAID-PPFE patients (20 SSc, 9 RA, 6 IIM6 primary SS, 5 overlap syndromes, 3 ANCA-associated vasculitides, 2 granulomatosis with polyangiitis, 1 microscopic polyangiitis, 1 UCTD, 1 SLE, 1 GCA and 21 patients with non-specified RAID). Dyspnoea was the most frequently reported symptom (37/48 patients, 77%). Patients frequently presented with a restrictive pattern and decline in diffusing lung capacity for carbon monoxide. During the follow-up, 7/12 patients had progression at imaging, 22/39 presented a generic clinical worsening, 19/38 had a functional deterioration and 15/43 remained stable. CONCLUSION: The present systematic literature review confirms that PPFE features are present in RAID. Rheumatologists should be aware of this new radiological pattern that holds a bad prognosis.


Assuntos
Doenças Autoimunes/complicações , Doenças Pleurais/etiologia , Fibrose Pulmonar/etiologia , Doenças Reumáticas/complicações , Humanos , Doenças Pleurais/diagnóstico , Doenças Pleurais/terapia , Fibrose Pulmonar/diagnóstico , Fibrose Pulmonar/terapia , Doenças Reumáticas/imunologia
10.
Reumatol. clín. (Barc.) ; 16(6): 437-446, nov.-dic. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-194661

RESUMO

OBJETIVO: Generar las recomendaciones para la atención de pacientes con enfermedades reumáticas que reciben terapias inmunomoduladoras e inmunosupresoras (fármacos convencionales, biológicos y moléculas pequeñas) durante la pandemia por COVID-19. MATERIALES Y MÉTODOS: Las recomendaciones se realizaron utilizando el método Delphi como herramienta de acuerdo. Se conformó un panel de expertos con trayectoria académica y experiencia en investigación en reumatología. Se realizó la búsqueda de la literatura y se generó el cuestionario del ejercicio Delphi conformado por 42 preguntas. El grado de acuerdo se logró con el 80% de aprobación de los participantes. RESULTADOS: Se conformó un grupo de 11 reumatólogos de 7 ciudades del país. La tasa de respuesta fue del 100% para las 3 rondas de consulta. En la primera ronda se logró acuerdo en 35 preguntas, en la segunda ronda 37 y en la tercera ronda se logró el acuerdo de las 42 preguntas. CONCLUSIÓN: La recomendación para la mayoría de los tratamientos inmunomoduladores utilizados en reumatología es continuar con las terapias en pacientes que no tengan la infección y suspenderlas en aquellos con diagnóstico de SARS-CoV-2/COVID-19


OBJECTIVE: To produce recommendations for patients with rheumatological diseases receiving immunomodulatory and immunosuppressive therapies (conventional drugs, biologicals, and small molecules) during the COVID-19 pandemic. MATERIALS AND METHODS: The recommendations were determined using the Delphi method as an agreement tool. A panel of experts was formed, with academic backgrounds and research experience in rheumatology. A literature search was conducted and 42 questions were generated. The level of agreement was made with 80% of approval by the participants. RESULTS: A group of eleven rheumatologists from 7 cities in the country participated. The response rate was 100% for the three consultation rounds. In the first round, agreement was reached on 35 questions, on 37 in the second round, and on 42 questions in the third round. CONCLUSION: The recommendation for the majority of the pharmacological treatments used in rheumatology is to continue with immunomodulatory or immunosuppressive therapies in patients who do not have the infection, and to suspend it in patients with a diagnosis of SARS-CoV-2/COVID-19


Assuntos
Humanos , Doenças Reumáticas/tratamento farmacológico , Fatores Imunológicos/administração & dosagem , Antirreumáticos/administração & dosagem , Infecções por Coronavirus/tratamento farmacológico , Doenças Reumáticas/complicações , Padrões de Prática Médica , Suspensão de Tratamento/tendências , Infecções por Coronavirus/epidemiologia , Pandemias/estatística & dados numéricos
14.
Aging (Albany NY) ; 12(20): 19923-19937, 2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-33080571

RESUMO

Coronavirus disease 19 (COVID-19) is currently a global pandemic that affects patients with other pathologies. Here, we investigated the influence of treatments for osteoporosis and other non-inflammatory rheumatic conditions, such as osteoarthritis and fibromyalgia, on COVID-19 incidence. To this end, we conducted a cross-sectional study of 2,102 patients being treated at the Rheumatology Service of Hospital del Mar (Barcelona, Spain). In our cohort, COVID-19 cumulative incidence from March 1 to May 3, 2020 was compared to population estimates for the same city. We used Poisson regression models to determine the adjusted relative risk ratios for COVID-19 associated with different treatments and comorbidities. Denosumab, zoledronate and calcium were negatively associated with COVID-19 incidence. Some analgesics, particularly pregabalin and most of the studied antidepressants, were positively associated with COVID-19 incidence, whereas duloxetine presented a negative association. Oral bisphosphonates, vitamin D, thiazide diuretics, anti-hypertensive drugs and chronic non-steroidal anti-inflammatory drugs had no effect on COVID-19 incidence in the studied population. Our results provide novel evidence to support the maintenance of the main anti-osteoporosis treatments in COVID-19 patients, which may be of particular relevance to elderly patients affected by the SARS-CoV-2 pandemic.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Cálcio/uso terapêutico , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Doenças Reumáticas/complicações , Vitamina D/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/induzido quimicamente , Estudos Transversais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/induzido quimicamente , Doenças Reumáticas/tratamento farmacológico , Espanha/epidemiologia
16.
RMD Open ; 6(2)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32878994

RESUMO

OBJECTIVES: Patients with inflammatory rheumatic diseases (IRD) infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be at risk to develop a severe course of COVID-19. The influence of immunomodulating drugs on the course of COVID-19 is unknown. To gather knowledge about SARS-CoV-2 infections in patients with IRD, we established a registry shortly after the beginning of the pandemic in Germany. METHODS: Using an online questionnaire (www.COVID19-rheuma.de), a nationwide database was launched on 30 March 2020, with appropriate ethical and data protection approval to collect data of patients with IRD infected with SARS-CoV-2. In this registry, key clinical and epidemiological parameters-for example, diagnosis of IRD, antirheumatic therapies, comorbidities and course of the infection-are documented. RESULTS: Until 25 April 2020, data from 104 patients with IRD infected with SARS-CoV-2 were reported (40 males; 63 females; 1 diverse). Most of them (45%) were diagnosed with rheumatoid arthritis, 59% had one or more comorbidities and 42% were treated with biological disease-modifying antirheumatic drugs. Hospitalisation was reported in 32% of the patients. Two-thirds of the patients already recovered. Unfortunately, 6 patients had a fatal course. CONCLUSIONS: In a short time, a national registry for SARS-CoV2-infected patients with IRD was established. Within 4 weeks, 104 cases were documented. The registry enables to generate data rapidly in this emerging situation and to gain a better understanding of the course of SARS-CoV2-infection in patients with IRD, with a distinct focus on their immunomodulatory therapies. This knowledge is valuable for timely information of physicians and patients with IRD, and shall also serve for the development of guidance for the management of patients with IRD during this pandemic.


Assuntos
Antirreumáticos/uso terapêutico , Produtos Biológicos/uso terapêutico , Infecções por Coronavirus/fisiopatologia , Pneumonia Viral/fisiopatologia , Sistema de Registros , Doenças Reumáticas/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite Psoriásica/complicações , Artrite Psoriásica/tratamento farmacológico , Artrite Reumatoide/complicações , Artrite Reumatoide/tratamento farmacológico , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/mortalidade , Feminino , Alemanha , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/tratamento farmacológico , Hospitalização , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/mortalidade , Polimialgia Reumática/complicações , Polimialgia Reumática/tratamento farmacológico , Prognóstico , Doenças Reumáticas/complicações , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/tratamento farmacológico , Índice de Gravidade de Doença , Espondilite Anquilosante/complicações , Espondilite Anquilosante/tratamento farmacológico , Adulto Jovem
17.
Rheumatol Int ; 40(11): 1753-1762, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32930863

RESUMO

The novel coronavirus outbreak induces many concerns about the management of pregnancy, as well as rheumatic and musculoskeletal diseases. The very rapid spread of the infection throughout all inhabited continents leads to a fast-growing number of infected with SARS-CoV-2 and requires answers and special recommendations to the most vulnerable group of people: pregnant woman and patients on immunomodulatory or immunosuppressive treatment. A systematic literature search was performed in Embase, MEDLINE, and Scopus database for studies describing COVID-19 infection in pregnant women diagnosed with rheumatic and musculoskeletal diseases. From the 1,115 initially identified articles, we selected 29 publications in the English language, from which 18 were eligible according to the inclusion criteria. Limited number of cases and further researches are required to evaluate the risk of transmission of SARS-CoV-2 from mother to her infant as well as clinical features of infection in pregnant women. The conclusions of different authors, despite the small number of cases, suggest that there is no vertical transmission in women diagnosed with COVID-19 pneumonia. Although the World Health Organization recently reported that pregnant patients do not have a higher risk of infection than the rest of the population, Royal College of Obstetricians & Gynecologists and The Royal College of Midwives for COVID-19 infection in pregnancy published Guidelines for pregnant women with suspected SARS-CoV-2 infection.Considerations about patients with rheumatic diseases on the immunosuppressive treatment required European League Against Rheumatism, American College of Rheumatology, British Society for Rheumatology, and Australian Rheumatology Association to publish recommendations for patients with rheumatic diseases and COVID-19. These algorithms are very important to the medical society, but many concerns, absence of experience, and many questions are still unanswered and need time to be resolved and proceed successfully in this global pandemic situation.


Assuntos
Betacoronavirus , Infecções por Coronavirus/transmissão , Pneumonia Viral/transmissão , Complicações Infecciosas na Gravidez , Doenças Reumáticas/complicações , Infecções por Coronavirus/terapia , Feminino , Humanos , Imunossupressores/uso terapêutico , Transmissão Vertical de Doença Infecciosa , Pandemias , Pneumonia Viral/terapia , Gravidez , Complicações Infecciosas na Gravidez/terapia , Doenças Reumáticas/tratamento farmacológico
18.
Curr Opin Rheumatol ; 32(5): 429-433, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32744823

RESUMO

PURPOSE OF REVIEW: There are currently many unanswered questions surrounding the management of patients with immune-mediated inflammatory diseases during the COVID-19 pandemic and several 'rapid' guidelines have been released, although are subject to be updated and changed in the near future. The purpose of this review is to discuss the approach to management of patients with immune-mediated diseases during the COVID-19 pandemic. RECENT FINDINGS: At present, there is little evidence to suggest an increased risk of COVID-19 infection or its complications in patients with immune-mediated diseases or associated with conventional or biologic disease modifying antirheumatic drugs; however, glucocorticoid use does appear to have negative associations. SUMMARY: Currently, conventional and biologic disease modifying antirheumatic drugs can be continued in the absence of SARS-CoV-2 exposure. In the case of exposure, with the exception of hydroxyhcloroquine and sulfasalazine, immunosuppression should be held for 2 weeks. Our recommendations and the guidelines we discuss here are based on C-level recommendations but help provide a framework for how to counsel our patients during this pandemic.


Assuntos
Antirreumáticos/uso terapêutico , Betacoronavirus , Competência Clínica , Infecções por Coronavirus/epidemiologia , Imunossupressão/métodos , Pneumonia Viral/epidemiologia , Doenças Reumáticas/tratamento farmacológico , Reumatologistas/normas , Comorbidade , Humanos , Pandemias , Doenças Reumáticas/complicações , Doenças Reumáticas/epidemiologia
20.
Reumatol Clin ; 16(6): 437-446, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32800760

RESUMO

OBJECTIVE: To produce recommendations for patients with rheumatological diseases receiving immunomodulatory and immunosuppressive therapies (conventional drugs, biologicals, and small molecules) during the COVID-19 pandemic. MATERIALS AND METHODS: The recommendations were determined using the Delphi method as an agreement tool. A panel of experts was formed, with academic backgrounds and research experience in rheumatology. A literature search was conducted and 42 questions were generated. The level of agreement was made with 80% of approval by the participants. RESULTS: A group of eleven rheumatologists from 7 cities in the country participated. The response rate was 100% for the three consultation rounds. In the first round, agreement was reached on 35 questions, on 37 in the second round, and on 42 questions in the third round. CONCLUSION: The recommendation for the majority of the pharmacological treatments used in rheumatology is to continue with immunomodulatory or immunosuppressive therapies in patients who do not have the infection, and to suspend it in patients with a diagnosis of SARS-CoV-2/COVID-19.


Assuntos
Antirreumáticos/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/complicações , Pandemias , Pneumonia Viral/complicações , Doenças Reumáticas/complicações , Adulto , Anti-Inflamatórios não Esteroides/efeitos adversos , Anti-Inflamatórios não Esteroides/uso terapêutico , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais/uso terapêutico , Antimaláricos/efeitos adversos , Antimaláricos/uso terapêutico , Antirreumáticos/efeitos adversos , Produtos Biológicos/efeitos adversos , Produtos Biológicos/uso terapêutico , Ensaios Clínicos como Assunto , Colômbia , Infecções por Coronavirus/tratamento farmacológico , Técnica Delfos , Interações Medicamentosas , Reposicionamento de Medicamentos , Glucocorticoides/efeitos adversos , Glucocorticoides/uso terapêutico , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/efeitos adversos , Fatores Imunológicos/uso terapêutico , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Estudos Multicêntricos como Assunto , Pneumonia Viral/tratamento farmacológico , Doenças Reumáticas/tratamento farmacológico
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