ABSTRACT
Abstract Spondyloarthritis (SpA) is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. Over some decades, nonsteroidal anti-inflammatory drugs (NSAIDs) have been the basis for the pharmacological treatment of patients with axial spondyloarthritis (axSpA). However, the emergence of the immunobiologic agents brought up the discussion about the role of NSAIDs in the management of these patients. The objective of this guideline is to provide recommendations for the use of NSAIDs for the treatment of axSpA. A panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis of randomized clinical trials for 15 predefined questions. The Grading of Recommendations, Assessment, Development and Evaluation methodology to assess the quality of evidence and formulate recommendations were used, and at least 70% agreement of the voting panel was needed. Fourteen recommendations for the use of NSAIDs in the treatment of patients with axSpA were elaborated. The purpose of these recommendations is to support clinicians' decision making, without taking out his/her autonomy when prescribing for an individual patient.(AU)
Subject(s)
Humans , Spondylitis, Ankylosing/drug therapy , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Guidelines as Topic/standards , Decision MakingABSTRACT
Abstract Spondyloarthritis is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. The classification axial spondyloarthritis is adopted when the spine and/or the sacroiliac joints are predominantly involved. This version of recommendations replaces the previous guidelines published in May 2013. A systematic literature review was performed, and two hundred thirty-seven studies were selected and used to formulate 29 recommendations answering 15 clinical questions, which were divided into four sections: diagnosis, non-pharmacological therapy, conventional drug therapy and biological therapy. For each recommendation the level of evidence supporting (highest available), the strength grade according to Oxford, and the degree of expert agreement (inter-rater reliability) is informed. These guidelines bring evidence-based information on clinical management of axial SpA patients, including, diagnosis, treatment, and prognosis.
Subject(s)
Humans , Practice Guidelines as Topic , Spondylarthritis/diagnosis , Spondylarthritis/therapy , Prognosis , BrazilABSTRACT
Objetivos: Definir o perfil do profissional que atende no setor primário de saúde na cidade de Sorocaba, analisar o meio em que está inserido e tentar identificar se há condições para o atendimento de doenças reumáticas de baixa complexidade e os possíveis motivos que levariam a um alto grau de encaminhamento aos especialistas. Métodos: Fizemos um estudo quantitativo no qual médicos da atenção básica de saúde foram convidados a responder um questionário que abordava aspectos pessoais do profissional, além de técnicos de quatro doenças reumáticas: osteoartrite, gota, fibromialgia e osteoporose, as quais serviram de base para avaliar o atendimento a doenças de baixa complexidade nas unidades básicas de saúde (UBS). Resultados: Observou-se que o profissional encontra-se inserido num sistema organizacional que dificulta sua atuação; além disso, perceberam-se certas dificuldades pessoais técnicas. Essas condições somadas acabam por ser fatores que determinam uma qualidade de atendimento aquém da esperada. Conclusão: É necessário que haja uma revisão de como a educação médica se dá, a fim de buscar uma formação mais qualificada e voltada para as necessidades básicas do sistema de saúde, além de uma reestruturação de todo sistema de saúde do ponto de vista de organização e gestão, para que haja uma condição adequada para o desenvolvimento de uma boa prática médica e, consequentemente, uma boa prestação de serviço à população. .
Objectives: The study had as main goal to define the profile of the attending professional working at the primary healthcare sector in the city of Sorocaba, and to analyze the environment in which this professional is inserted, trying to identify if there are conditions for the care of low-complexity rheumatic diseases and possible reasons that would lead to a high degree of referral to specialists. Methods: A quantitative study was performed in which physicians of primary health care were invited to answer a questionnaire that addressed personal aspects, besides the technical aspects of four rheumatic diseases: osteoarthritis, gout, fibromyalgia and osteoporosis, which served as the basis for evaluating the care for low-complexity diseases in UBSs. Results: It was observed that the professional is part integral of an organizational system that hinders his/her performance; moreover, certain personal difficulty techniques were realized. Together, these conditions turned out to be the factors that determine a quality of care that falls short of that expected. Conclusion: There must be a review of how medical education is offered, in order to seek a more qualified training, focused on the basic needs of the health system, as well as a restructuring of the entire health system in terms of its organization and management, in order to attain a suitable condition for the development of a good medical practice, and thus, for providing a good service to the community. .
Subject(s)
Humans , Male , Female , Adult , Primary Health Care , Rheumatic Diseases/diagnosis , Brazil , Urban HealthABSTRACT
O tornozelo é sítio frequente de sintomas dolorosos em atletas e não atletas. A dor localizada na região posterior pode ser o resultado final de diversas patologias, sendo um desafio diagnóstico para o reumatologista. A síndrome do impacto (pinçamento) posterior do tornozelo, também denominada síndrome os trigonum e síndrome compressiva tibiotalar posterior, é um distúrbio clínico caracterizado por dor aguda ou crônica na região posterior do tornozelo, desencadeada pela flexão plantar forçada, que promove microtrauma crônico repetitivo. A patologia do processo os trigonum-talar é a causa mais comum dessa síndrome, mas existem outras causas, como tenossinovite do flexor longo do hálux, osteocondrite de tornozelo, doença da articulação subtalar e fratura. O diagnóstico baseia-se na história clínica e exame físico, e complementado por achados na radiografia simples (RX), ultrassom (US), cintilografia, tomografia computadorizada (TC) e ressonância magnética (RM). Destacamos o RX por seu baixo custo e boa sensibilidade, o US pela possibilidade de guiar infiltrações terapêuticas e a RM pela possibilidade de avaliar partes moles adjacentes.
The ankle is a common site of painful symptoms in athletes and nonathletes. Posterior ankle pain can be the end result of several pathologies, and a diagnostic challenge for rheumatologists. The posterior ankle impingement syndrome, also known as os trigonum syndrome and posterior tibiotalar compression syndrome, is a clinical disorder characterized by acute or chronic posterior ankle pain triggered by forced plantar flexion, which causes chronic repetitive microtrauma. Pathology of the os trigonum-talar process is the most common cause of this syndrome, but there are other causes, such as tenosynovitis of the flexor hallucis longus, ankle osteochondritis, subtalar joint disease, and fracture. Diagnosis is based on clinical history and physical examination, and complemented by findings on plain radiography (RX), ultrasound (US), scintigraphy, computed tomography (CT), and magnetic resonance imaging (MRI). It is worth noting that RX has low cost and good sensitivity, US can provide guidance to therapeutic infiltrations, and MRI allows the assessment of surrounding soft tissues.