ABSTRACT
Abstract Sjogren's syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs, associated with sicca syndrome but also with systemic involvement with varying degrees of severity. Despite their importance, some systemic manifestations, mainly liver, gastrointestinal, and pancreatic are not routinely evaluated. To address these manifestations, the Sjögren's Syndrome Committee of the Brazilian Society of Rheumatology conducted a broad systematic review of the literature on studies investigating prevalence and diagnosis of these symptoms in Sjogren´s patients and made recommendations based on the findings. Agreement between the experts was achieved using the Delphi method. This is the second part of this guideline, providing 6 recommendations for liver, gastrointestinal, and pancreatic care of SS patients.
ABSTRACT
Abstract Sjogren's Syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs, associated with sicca syndrome but also with systemic involvement with varying degrees of severity. Despite their importance, these systemic manifestations are not routinely evaluated and there is no homogenous approach to their diagnosis or evaluation. To close this gap, a panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis on the identification of epidemiologic and clinical features of these manifestations and made recommendations based on the findings. Agreement between the experts was achieved using the Delphi method. The first part of this guideline summarizes the most important topics, and 11 recommendations are provided for the articular, pulmonary, and renal care of SS patients.
ABSTRACT
Abstract Sjogren's syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs. Women with SS often experience gynecological symptoms due to the disease and need extra care regarding their sexual activity, reproductive health and during pregnancy, conditions that are not properly conducted in the clinical practice. To cover this gap, a panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis on the identification of symptoms, diagnosis, monitoring, prognosis, and treatment of these manifestations. A Focus Group meeting was held and included experts in the field and methodologists, based on a previously developed script, with themes related to the objective of the study. The most important topics were summarized and 11 recommendations were provided.
ABSTRACT
ABSTRACT The authors present a case of necrotizing scleritis after pterygium excision successfully treated with rituximab after attempts with high doses of corticosteroids and immunosuppressive drugs. A literature review revealed case reports and a phase I/II dose-ranging randomized clinical trial using rituximab for necrotizing scleritis with or without association with autoimmune disease. This is the only case report on rituximab treatment for necrotizing scleritis after pterygium surgery. In cases with refractoriness to immunosuppressive drugs, a CD20 antibody can be used.
RESUMO Os autores apresentam um caso de sucesso no tratamento com rituximabe de esclerite necrosante após cirurgia de pterígio refratário a altas doses de corticosteroides e drogas imunossupressoras. Uma revisão da literatura direcionada ao uso de rituximabe para tratamento de esclerites necrosantes revelou relatos de casos e um estudo clínico randomizando fase I/II. Este é o único caso descrito de rituximabe para o tratamento de esclerite necrosante pós cirúrgica. O uso de anticorpo anti-CD20 pode ser uma opção em casos refratários aos imunossupressores no tratamento da esclerite necrosante pós-cirúrgica.
Subject(s)
Humans , Female , Middle Aged , Pterygium/surgery , Scleritis/drug therapy , Rituximab/therapeutic use , Immunologic Factors/therapeutic use , Postoperative Complications/etiology , Postoperative Complications/drug therapy , Sclera/drug effects , Sclera/pathology , Ophthalmologic Surgical Procedures/adverse effects , Scleritis/etiology , Reproducibility of Results , Treatment OutcomeABSTRACT
RESUMOAs recomendações propostas pela Comissão de Síndrome de Sjögren da Sociedade Brasileira de Reumatologia para tratamento da síndrome de Sjögren foram baseadas em uma revisão sistemática da literatura nas bases de dados Medline (PubMed) e Cochrane até outubro de 2014 e opinião de especialistas na ausência de artigos sobre o assunto. Foram incluídos 131 artigos classificados de acordo com Oxford & Grade. Essas recomendações foram elaboradas com o objetivo de orientar o manejo adequado e facilitar o acesso aos tratamentos para aqueles pacientes com adequada indicação de recebê-los, considerando o contexto socioeconômico brasileiro e os medicamentos disponíveis no país.
ABSTRACTThe recommendations proposed by the Sjögren's Syndrome Committee of the Brazilian Society of Rheumatology for the treatment of Sjögren's syndrome were based on a systematic review of literature in Medline (PubMed) and the Cochrane databases until October 2014 and on expert opinion in the absence of studies on the subject. 131 articles classified according to Oxford & Grade were included. These recommendations were developed in order to guide the management and facilitate the access to treatment for those patients with an appropriate indication, considering the Brazilian socioeconomic context and pharmacological agents available in this country.
Subject(s)
Humans , Sjogren's Syndrome/therapy , Brazil , Decision TreesABSTRACT
Granulomatous polyangiitis is a systemic disease that may affect any organ, with a predilection for the upper respiratory tract, lungs and kidneys. This article aims to report a case of a patient with atypical nodular scleritis as the initial manifestation of granulomatous polyangiitis (Wegener), mimicking a case of tuberculosis. The patient presented ocular hyperemia and lower progressive visual acuity for 1.5 years, followed by eye pain for two months. The patient had subpleural nodules with soft tissue density, increased pulmonary lymph nodes and discrete bilateral pleural thickening, with negative alcohol-resistant acid bacilli (BAAR). The histological diagnosis revealed a granulomatous vasculitis suggestive of non-infectious vasculitis (granulomatous polyangiitis). Cyclophosphamide pulse therapy was initiated.
Poliangiite granulomatosa é uma doença sistêmica que afeta qualquer órgão, com predileção pelo trato respiratório superior, pulmões e rins. Este artigo tem como objetivo relatar um caso atípico de uma paciente com esclerite nodular como manifestação inicial da poliangiite granulomatosa (Wegener), mimetizando um quadro de tuberculose. A paciente apresentou hiperemia ocular e baixa acuidade visual progressiva por 1,5 anos, seguido por dor ocular por dois meses. A paciente possuía nódulos subpleurais com densidade de partes moles, linfonodomegalia em janela aorto-pulmonar e espessamento pleural bilateral discreto, negativo para bacilos álcool-ácido resistentes (BAAR). O diagnóstico histológico revelou uma vasculite granulomatosa sugestiva de vasculite não infecciosa (poliangiite granulomatosa). Foi iniciada pulsoterapia com ciclofosfamida.
Subject(s)
Humans , Female , Middle Aged , Cyclophosphamide/administration & dosage , Scleritis/diagnosis , Granulomatosis with Polyangiitis/diagnosis , Granulomatosis with Polyangiitis/drug therapy , Vasculitis , Visual Acuity , Pulse Therapy, DrugABSTRACT
Os anti-inflamatórios não hormonais (AINEs) são drogas frequentemente utilizadas para o controle da dor, febre e inflamação. Embora os benefícios obtidos com o uso de AINEs sejam importantes, principalmente nas doenças inflamatórias crônicas, cerca de 25% dos pacientes apresentam efeitos colaterais que restringem seu uso na prática clínica. Os AINEs não são considerados drogas modificadoras de doenças na artrite reumatoide e devem ser utilizados somente como sintomáticos. Pelo fato de terem ambas as funções (propriedades analgésicas e anti-inflamatórias), os pacientes claramente os preferem para tratamento da osteoartrite. Os AINEs são efetivos no tratamento das lombalgias, qualquer classe de AINH pode ser utilizada, não existindo evidências de que uma classe seja mais efetiva que a outra no alívio das dores lombares. Deve-se levar em conta o risco de efeitos colaterais pela idade do paciente ou história prévia de úlcera gástrica e por insuficiência renal.
Subject(s)
Humans , Anti-Inflammatory Agents , Arthritis, Rheumatoid/drug therapy , Low Back Pain/drug therapy , Pain/drug therapy , Osteoarthritis/drug therapyABSTRACT
A osteoartrite (OA) é uma desordem articular que leva ao envolvimento global da articulação (osso subcondral, ligamentos, cápsula articular, membrana sinovial e músculos periarticulares). Os desfechos clínicos e patológicos de uma variedade de eventos biológicos e mecânicos levam à falência estrutural e funcional das articulações sinoviais. É a doença articular mais prevalente e é a principal causa de dor e desabilidade em indivíduos idosos. As alterações radiográficas são praticamente universais após os 60 anos de idade, mas as queixas clínicas ocorrem em torno de 20% dos pacientes. O diagnóstico é dado pelas queixas clínicas, os achados no exame físico e as alterações radiográficas. O tratamento atual é dividido em medidas não farmacológicas e farmacológicas.