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1.
Adv Rheumatol ; 64(1): 52, 2024 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-38987832

RESUMO

BACKGROUND: Systemic sclerosis (SSc) is a rare chronic autoimmune disease with heterogeneous manifestations. In the last decade, several clinical trials have been conducted to evaluate new treatment options for SSc. The purpose of this work is to update the recommendations of the Brazilian Society of Rheumatology in light of the new evidence available for the pharmacological management of SSc. METHODS: A systematic review including randomized clinical trials (RCTs) for predefined questions that were elaborated according to the Patient/Population, Intervention, Comparison, and Outcomes (PICO) strategy was conducted. The rating of the available evidence was performed according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. To become a recommendation, at least 75% agreement of the voting panel was needed. RESULTS: Six recommendations were elaborated regarding the pharmacological treatment of Raynaud's phenomenon, the treatment (healing) and prevention of digital ulcers, skin involvement, interstitial lung disease (ILD) and gastrointestinal involvement in SSc patients based on results available from RCTs. New drugs, such as rituximab, were included as therapeutic options for skin involvement, and rituximab, tocilizumab and nintedanib were included as therapeutic options for ILD. Recommendations for the pharmacological treatment of scleroderma renal crisis and musculoskeletal involvement were elaborated based on the expert opinion of the voting panel, as no placebo-controlled RCTs were found. CONCLUSION: These guidelines updated and incorporated new treatment options for the management of SSc based on evidence from the literature and expert opinion regarding SSc, providing support for decision-making in clinical practice.


Assuntos
Doença de Raynaud , Reumatologia , Escleroderma Sistêmico , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/tratamento farmacológico , Humanos , Brasil , Reumatologia/normas , Doença de Raynaud/tratamento farmacológico , Sociedades Médicas , Doenças Pulmonares Intersticiais/tratamento farmacológico , Anticorpos Monoclonais Humanizados/uso terapêutico , Rituximab/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Úlcera Cutânea/etiologia , Antirreumáticos/uso terapêutico
2.
Adv Rheumatol ; 59(1): 5, 2019 01 22.
Artigo em Inglês | MEDLINE | ID: mdl-30670098

RESUMO

Nailfold capillaroscopy (NFC) is a reproducible, simple, low-cost, and safe imaging technique used for morphological analysis of nail bed capillaries. It is considered to be extremely useful for the investigation of Raynaud's phenomenon and for the early diagnosis of systemic sclerosis (SSc). The capillaroscopic pattern typically associated with SSc, scleroderma ("SD") pattern, is characterized by dilated capillaries, microhemorrhages, avascular areas and/or capillary loss, and distortion of the capillary architecture. The aim of these recommendations is to provide orientation regarding the relevance of NFC, and to establish a consensus on the indications, nomenclature, the interpretation of NFC findings and the technical equipments that should be used. These recommendations were formulated based on a systematic literature review of studies included in the database MEDLINE (PubMed) without any time restriction.


Assuntos
Angioscopia Microscópica/métodos , Doenças Reumáticas/diagnóstico por imagem , Artrite Reumatoide/diagnóstico por imagem , Brasil , Capilares/diagnóstico por imagem , Capilares/patologia , Dermatomiosite/diagnóstico por imagem , Dermatomiosite/patologia , Diagnóstico Precoce , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/patologia , Angioscopia Microscópica/instrumentação , Angioscopia Microscópica/normas , Doença Mista do Tecido Conjuntivo/diagnóstico por imagem , Doença Mista do Tecido Conjuntivo/patologia , Doença de Raynaud/diagnóstico por imagem , Doença de Raynaud/patologia , Doenças Reumáticas/patologia , Reumatologia , Escleroderma Sistêmico/diagnóstico por imagem , Escleroderma Sistêmico/patologia , Sociedades Médicas , Vasculite Sistêmica/diagnóstico por imagem , Terminologia como Assunto
3.
Adv Rheumatol ; 59: 5, 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1088629

RESUMO

Abstract Nailfold capillaroscopy (NFC) is a reproducible, simple, low-cost, and safe imaging technique used for morphological analysis of nail bed capillaries. It is considered to be extremely useful for the investigation of Raynaud's phenomenon and for the early diagnosis of systemic sclerosis (SSc). The capillaroscopic pattern typically associated with SSc, scleroderma ("SD") pattern, is characterized by dilated capillaries, microhemorrhages, avascular areas and/or capillary loss, and distortion of the capillary architecture. The aim of these recommendations is to provide orientation regarding the relevance of NFC, and to establish a consensus on the indications, nomenclature, the interpretation of NFC findings and the technical equipments that should be used. These recommendations were formulated based on a systematic literature review of studies included in the database MEDLINE (PubMed) without any time restriction.


Assuntos
Humanos , Escleroderma Sistêmico/diagnóstico , Guias de Prática Clínica como Assunto , Vasoespasmo Coronário/diagnóstico , Angioscopia Microscópica/instrumentação , Esclerodermia Difusa/diagnóstico
4.
Clin Exp Rheumatol ; 34 Suppl 100(5): 193-199, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26940067

RESUMO

OBJECTIVES: to describe normal patterns of nailfold videocapillaroscopy (NVC) in healthy children and adolescents; to quantify the relationship between age and capillary dimensions, intercapillary distance and number of capillaries/mm; to evaluate the inter and intraobserver concordance. METHODS: Cross-sectional study including 100 healthy participants aged 5 to 18 years. Capillary dimensions (capillary loop length, capillary width and intercapillary distance) and number of capillaries/mm were evaluated in 900 capillaries using stereomicroscope under 100x magnification. Intra and inter observer agreements were tested. RESULTS: The capillary dimensions (mean ± SD) were: capillary loop length 278.6±60.3 µm, intercapillary distance 124.1±28.1 µm, capillary width 15.0±2.6 µm. Teenagers between 15 and 18 years had longer and more enlarged capillaries than the other age groups (p<0.001 and p=0.012 respectively). We also found a significant increase in the number of capillaries/mm with age (p<0.001). There was a positive correlation between age and number of capillaries/mm, capillary length, and capillary width (p<0.001, R=0.796; p<0.001, R=0.368; p=0.004, R=0.285, respectively). There was a good intra and interobserver concordance. Enlarged capillary and avascular areas were present in 11% and 10% of capillaries respectively. A weak negative correlation was found between the intercapillary distance and the number of capillaries/mm (p=0.05; R=-0.20). CONCLUSIONS: There is a wide variability in the capillary morphology among healthy individuals. There was a positive correlation between age and number of capillaries/mm, capillary length, and capillary width. In addition, NVC has been shown to be a reproducible method.


Assuntos
Capilares/anatomia & histologia , Angioscopia Microscópica , Unhas/irrigação sanguínea , Adolescente , Fatores Etários , Criança , Pré-Escolar , Estudos Transversais , Feminino , Voluntários Saudáveis , Humanos , Masculino , Variações Dependentes do Observador , Valor Preditivo dos Testes , Valores de Referência , Reprodutibilidade dos Testes
5.
Clin Exp Rheumatol ; 31(2 Suppl 76): 103-8, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23324736

RESUMO

OBJECTIVES: Peripheral microangiopathy is a hallmark of systemic sclerosis (SSc) and can be early detected by nailfold capillaroscopy (NFC). This study aimed to examine whether more severe peripheral microangiopathy at NFC are predictive factor for death in SSc patients. METHODS: 135 SSc patients who performed NFC between June 2001 and July 2009 were included. The following NFC parameters were evaluated: number of capillary loops/mm, avascular score (scored from 0 to 3), and number of enlarged and giant capillary loops. Univariate and multivariate regression models were used to analyse the association of mortality with NFC and clinical parameters. RESULTS: At the time of the analysis (August 2010), 123 patients were alive, and 12 were dead. By univariate analysis, male gender, forced vital capacity <75% predicted, higher number of giant capillary loops, and an avascular score >1.5 on NFC were associated with a significantly increase risk of death. By multivariate analysis, an avascular score >1.5 was the only independent predictor of death (hazard ratio 2.265). Survival rates from diagnosis at 1, 5 and 10 years were lower in patients with avascular score >1.5 (97%, 86%, and 59%, respectively) compared with those with avascular score ≤1.5 (97%, 97%, and 91% respectively) (p=0.009 by log rank test). CONCLUSIONS: Avascular scores higher than 1.5 at NFC was an independent predictor of death in SSc, suggesting that NFC can be useful for predicting SSc outcome.


Assuntos
Angioscopia Microscópica , Unhas/irrigação sanguínea , Escleroderma Sistêmico/mortalidade , Escleroderma Sistêmico/fisiopatologia , Adulto , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Valor Preditivo dos Testes , Doença de Raynaud/mortalidade , Doença de Raynaud/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Capacidade Vital
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