RESUMO
OBJECTIVE: We evaluated the incidence of and the main risk factors associated with cutaneous adverse events in patients with chronic inflammatory arthritis following anti-TNF-α therapy. METHODS: A total of 257 patients with active arthritis who were taking TNF-α blockers, including 158 patients with rheumatoid arthritis, 87 with ankylosing spondylitis and 12 with psoriatic arthritis, were enrolled in a 5-year prospective analysis. Patients with overlapping or other rheumatic diseases were excluded. Anthropometric, socioeconomic, demographic and clinical data were evaluated, including the Disease Activity Score-28, Bath Ankylosing Spondylitis Disease Activity Index and Psoriasis Area Severity Index. Skin conditions were evaluated by two dermatology experts, and in doubtful cases, skin lesion biopsies were performed. Associations between adverse cutaneous events and clinical, demographic and epidemiological variables were determined using the chi-square test, and logistic regression analyses were performed to identify risk factors. The significance level was set at p<0.05. RESULTS: After 60 months of follow-up, 71 adverse events (73.85/1000 patient-years) were observed, of which allergic and immune-mediated phenomena were the most frequent events, followed by infectious conditions involving bacterial (47.1%), parasitic (23.5%), fungal (20.6%) and viral (8.8%) agents. CONCLUSION: The skin is significantly affected by adverse reactions resulting from the use of TNF-α blockers, and the main risk factors for cutaneous events were advanced age, female sex, a diagnosis of rheumatoid arthritis, disease activity and the use of infliximab. .
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Anticorpos Monoclonais/efeitos adversos , Antirreumáticos/efeitos adversos , Artrite/tratamento farmacológico , Dermatopatias/induzido quimicamente , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Fatores Etários , Artrite Psoriásica/tratamento farmacológico , Doença Crônica , Seguimentos , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Estatísticas não Paramétricas , Inquéritos e Questionários , Pele/efeitos dos fármacos , Espondilite Anquilosante/tratamento farmacológico , Fatores de Tempo , Resultado do TratamentoRESUMO
Esta revisäo das principais emergências reumatológicas está dividida em três partes. Na primeira, discute-se o diagnóstico diferencial e a terapêutica dos problemas reumáticos como apresentaçäo inicial aguda, como as periartrites, artrites e miosites. Na segunda, trata-se das complicaçöes agudas de doenças reumáticas crônicas ou recidivantes, como artrite reumatóide, lupus eritematoso, febre reumática e vasculites. Finalmente, apresenta-se e se analisa a experiência de atendimento de aproximadamente 200 destes casos na Unidade de Emergência do Hospital das Clínicas da FMRP no período de 1990 a 1991