RESUMO
The objective of the study was to evaluate the incidence of Systemic Lupus Erythematosus (SLE) in a tropical urban community (Natal city, Brazil). Only patients living in Natal, a city in the northeastern area of Brazil, older than 15 years, and who fulfilled at least four of the American College of Rheumatology criteria between 1 January 2000 and 31 December 2000, were included. Four sources were used to identify new cases of SLE: (1) the University Hospital; (2) 'health units' and hospitals of the public health network; (3) specialists at private hospitals and outpatient clinics; and (4) three laboratories performing antinuclear antibody (ANA) determination. Census data from 2000 for Brazilian population was used to calculate incidence rate. The standardized mortality ratio (SMR) method and 95% confidence intervals (95% CI) were calculated. Forty-three patients were diagnosed as new SLE cases in 2000. The calculated incidence was 8.7/100,000/year (95% CI 6.3-11.7). Thirty-eight patients were female 14.1/100,000/year (95% CI 10.0-19.3) and five were male 2.2/100,000/year (95% CI 0.7-5.2). The mean age of new SLE cases was 31.8 years old. (95% CI 27.8-35.8). The mean age for females was 31.4 and for males was 35.0 years old. The median of disease duration (time between onset of the first ACR criterion for SLE and diagnosis) was 10 months (1-72 months). This study demonstrated a high incidence of SLE in Natal, apparently higher than reported in other places. The mean age at diagnosis seems lower than referred by other studies. The observed differences may be due to ethnic and/or environmental factors.
Assuntos
Lúpus Eritematoso Sistêmico/etnologia , Adolescente , Adulto , Idoso , População Negra , Brasil/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , População Urbana/estatística & dados numéricos , População BrancaRESUMO
Renal abnormalities have been reported in Ankylosing Spondylitis (AS) patients. Possible mechanisms include the effects of nonsteroidal anti-inflammatory drugs (NSAIDs), an increased incidence of glomerulonephritis, particularly the ones associated with deposition of IgA-containing immune complexes and the renal deposition of amyloid. These observations prompted us to evaluate in detail the frequency and severity of renal dysfunction in 40 AS patients, consecutively selected attending the rheumatology disease unit outpatient clinic at Escola Paulista de Medicina, using sensitive tests of glomerular and tubular function. Fourteen of the 40 patients presented one or more signs of renal involvement: microscopic hematuria (9 patients), microalbuminuria (4 patients), decreased renal function assessed by serum creatinine (2 patients), and creatinine clearance (4 patients). None of the patients presented increased urinary excretion of retinol binding protein (RBP). The finding of renal abnormalities in 35% of our patients suggests that in this illness evidence of renal involvement should be actively investigated.
Assuntos
Rim/fisiopatologia , Espondilite Anquilosante/complicações , Espondilite Anquilosante/fisiopatologia , Adolescente , Adulto , Idoso , Albuminúria/etiologia , Anti-Inflamatórios não Esteroides/efeitos adversos , Creatinina/sangue , Creatinina/urina , Feminino , Hematúria/etiologia , Humanos , Rim/patologia , Nefropatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Espondilite Anquilosante/patologiaRESUMO
OBJECTIVE: To evaluate the sensitivity and specificity of the ESSG criteria when applied to Brazilian patients with SpA and control patients with other rheumatic diseases. METHODS: Seventy patients with spondylarthropathies and 62 patients with other rheumatic diseases were interviewed, examined and had their charts reviewed. The diagnoses of the diseases were based on published diagnostic guidelines or classification criteria. Data were also collected according to the ESSG criteria. RESULTS: The sensitivity and specificity of the ESSG classification criteria were 98.5% and 88.7%, respectively. The sensitivities of the criteria in the different subgroups of SpA ranged from a low of 97.7% in AS to a high of 100% in other SpA studied. CONCLUSION: Despite differences in the socio-cultural and geographic characteristics and in individual disease frequencies, the ESSG preliminary classification criteria performed well when applied to Brazilian patients.
Assuntos
Guias de Prática Clínica como Assunto , Doenças da Coluna Vertebral/classificação , Brasil , Europa (Continente) , Feminino , Humanos , Masculino , Doenças Reumáticas/classificação , Sensibilidade e EspecificidadeRESUMO
The purpose of this study was to develop some of the focus group discussion (FGD) potentialities in order to provide information on patients' understanding of the origin and management of their medical condition. Fifteen ankylosing spondylitis (AS) patients (mean age = 32.6 yr and mean disease duration = 13.4 yr) were selected from the Rheumatic Disease Unit (RDU) out-patient clinic at Escola Paulista de Medicina, São Paulo, Brazil, to take part in this study. The FGD constituted two sessions, with eight patients in the first and seven in the second. The moderator raised specific questions about the patients' understanding of the pathology, the treatment and how the illness affected their quality of life. It was observed through the FGD that patients believed that their illness onset was due to some physical trauma. Clinicians should inquire about this tissue to be sure that their individual patients do not have this false belief. Also, it is necessary to improve the methods for early diagnosis and to develop further studies to determine and assess the parameters of disease activity. And finally, FGD may be of use in establishing a self-help group for individuals with chronic diseases, such as AS. In conclusion the FGD is an available technique that should be used more frequently in medicine to gather global qualitative data.
Assuntos
Grupos Focais , Entrevistas como Assunto , Qualidade de Vida , Espondilite Anquilosante/fisiopatologia , Adulto , Humanos , Pessoa de Meia-Idade , Prognóstico , Espondilite Anquilosante/etiologia , Espondilite Anquilosante/terapiaRESUMO
OBJECTIVE: This study was aimed at the evaluation of patient preferences concerning long-term methotrexate (MTX) therapy and whether or not to perform unselective liver biopsy to detect serious liver disease due to MTX therapy in rheumatoid arthritis (RA). METHODS: Seventeen literate patients with RA consecutively selected from a rheumatic disease unit and 17 rheumatologists (asked to consider themselves as RA patients) were assessed by a trained interviewer. The Bedside Decision Board instrument was used to assess the patient preference. Scenarios described the options in terms of follow-up for RA patients treated with MTX. The benefits and risks of liver biopsy, defined according to the published literature, were presented to RA patients and rheumatologists in an unbiased fashion. RESULTS: Twelve patients (71%) preferred not to be subjected to the liver biopsy within 1 month, even though they had already taken MTX for 3 years, and consequently ran the risk of development of cirrhosis in the long term. Conversely, 12 rheumatologists (71%) preferred to undergo an unselective liver biopsy. CONCLUSION: Given patients' preferences, liver biopsy following long term MTX treatment should not be performed unselectively. It can be postulated that rheumatologists did not perceive liver biopsy as an intimidating procedure or were influenced by the until recently recommended guidelines for following up patients treated with MTX.