Assuntos
Controle de Doenças Transmissíveis , Infecções por Coronavirus , Atenção à Saúde , Saúde Mental , Pandemias , Pneumonia Viral , Doenças Reumáticas , Reumatologia , Telemedicina/métodos , Antirreumáticos/farmacologia , Betacoronavirus , COVID-19 , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Atenção à Saúde/organização & administração , Atenção à Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Inovação Organizacional , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Padrões de Prática Médica/tendências , Doenças Reumáticas/epidemiologia , Doenças Reumáticas/terapia , Doenças Reumáticas/virologia , Reumatologia/métodos , Reumatologia/tendências , SARS-CoV-2 , Índice de Gravidade de DoençaRESUMO
Social media has become a key component of contemporary medicine, and the rheumatology subspecialty is not an exemption. We found that just six of the 40 key peer-reviewed rheumatology journals have found it sensible to incorporate the new appointment of a Social Media Editor-or a similar designation-into their Editorial Boards. We propose that the role of a social media editor is a trinomial: not only a technological work to promote digital engagement but also an activity of ethical guidance and a cultural challenge dealing with worldwide cultural and mindset diversity.
Assuntos
Políticas Editoriais , Editoração/tendências , Mídias Sociais/tendências , Humanos , Disseminação de Informação/métodos , Publicações Periódicas como Assunto , Reumatologia/tendênciasRESUMO
Several groups of investigators have described the presence of small fiber neuropathy in fibromyalgia patients. This writing discusses how this new finding could renovate fibromyalgia concept, diagnosis, and treatment. Predominant rheumatology thinking proposes fibromyalgia as a "centralized pain syndrome." An alternative hypothesis views fibromyalgia as a stress-related dysautonomia with neuropathic pain features. Dorsal root ganglia may be the key autonomic-nociceptive short-circuit sites. The recent recognition of small fiber neuropathy in a large subgroup of fibromyalgia patients reinforces the dysautonomia-neuropathic hypothesis and validates fibromyalgia pain. These new findings support fibromyalgia as a primarily neurological entity, nevertheless, rheumatologist will likely remain the best equipped specialist to diagnose fibromyalgia and differentiate it from other multi-symptomatic rheumatic syndromes. Skin biopsy and corneal confocal microscopy will probably become useful fibromyalgia diagnostic tests. Dorsal root ganglia sodium channel blockers are potential fibromyalgia analgesic medications. Subgroups of young girls with "autoimmune neuropathic fibromyalgia" may respond to immunoglobulin therapy. Multimodal intervention directed to regain autonomic nervous system resilience will likely remain the cornerstone for fibromyalgia therapy.
Assuntos
Fibromialgia/complicações , Reumatologia/tendências , Neuropatia de Pequenas Fibras/complicações , Sistema Nervoso Autônomo , Biópsia , Córnea/diagnóstico por imagem , Córnea/patologia , Fibromialgia/fisiopatologia , Gânglios Espinais , Humanos , Neurologia/métodos , Disautonomias Primárias/fisiopatologia , Reumatologia/métodos , Pele/patologia , Neuropatia de Pequenas Fibras/fisiopatologia , Canais de Sódio/químicaRESUMO
ResumenEn los últimos 15 años se han desarrollado terapias y esquemas terapéuticos para inducir la remisión a la gran mayoría de enfermedades reumatológicas. La mejoría clínica lograda se consigue a expensas de una inmunosupresión más agresiva y específica, lo que conlleva un aumento en el riesgo de infecciones. La principal causa de muerte de las enfermedades autoinmunes, en los primeros 5 años de evolución, es la infección secundaria a la inmunosupresión. El objetivo del presente trabajo fue elaborar un documento de consenso con el afán de reducir este riesgo, basado en la mejor evidencia médica disponible, utilizando los recursos disponibles en el hospital para disminuir la morbimortalidad de los pacientes que reciben estas terapias. Contar con un documento de consenso permitirá minimizar los efectos secundarios y mejorar la acción terapéutica, con mayores oportunidades de remisión y una más adecuada utilización del recurso institucional.
AbstractIn the last 15 years therapies and therapeutic schemes have been developed to induce remission to the vast majority of rheumatologic diseases. The clinical improvement achieved is at the cost of a more aggressive and specific immunosuppression, which leads to an increase in the risk of infections. The main cause of death of autoimmune diseases in the first 5 years of evolution is infection secondary to immunosuppression. The objective of the present study was to develop a consensus document with the aim of reducing this risk of infection, based on the best available medical evidence, using the resources available in our hospital to reduce the morbidity and mortality of patients receiving these therapies. Having a consensus document will allow us to minimize side effects and improve therapeutic action with greater opportunities for referral and better utilization of institutional resources.
Assuntos
Humanos , Terapia Biológica/efeitos adversos , Doenças Reumáticas/tratamento farmacológico , Doenças Reumáticas/terapia , Reumatologia/tendênciasRESUMO
Epidemiologic data from recent decades show a significant increase in the prevalence and incidence of gout worldwide, in addition to changes in its clinical expression. Our objective was to compare the frequency of the severity of gout and disability in two patient groups at our clinic during different periods. We included and compared data of two groups: group A (1995-2000), patients from previous report, and group B (2010-2014), the baseline data of current patients participating in a cohort (GRESGO). This evaluation included data of socioeconomic and educational levels, demographics, associated diseases, previous treatment, clinical and biochemical data, and disability evaluated using the Health Assessment Questionnaire (HAQ). We included data of 564 gout patients. Participants were 35.7 ± 12.7 years old at onset and had 12.0 ± 9.2-years disease duration at their first evaluation in our department. Group B patients were younger, had higher educational and socioeconomic levels, and had more severe disease. However, this group had less frequency of some associated diseases and significantly higher HAQ scores. With increased HAQ score, a higher number of acute flares and tender, limited-to-motion, and swollen joints were seen. The spectrum of gout has changed over the past decade. A higher percentage of our patients had a severe form of disease, were younger, had earlier disease onset, and had more disability reflected in higher HAQ scores. In our current patient group, the variable most associated with disability was limited-to-motion joints; however, the number of acute flares and tender and swollen joints was also higher in patients with greater disability.
Assuntos
Pessoas com Deficiência , Gota/diagnóstico , Gota/fisiopatologia , Adolescente , Adulto , Estudos de Coortes , Avaliação da Deficiência , Feminino , Gota/epidemiologia , Humanos , Articulações/fisiopatologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Reumatologia/métodos , Reumatologia/tendências , Inquéritos e Questionários , Adulto JovemRESUMO
Over the years, ultrasound (US) has accumulated important evidence supporting its relevant role for the assessment of inflammatory processes of different rheumatologic diseases, as well as in the follow-up in assessing the response to different therapeutic approaches. This has been possible because of the increase in training, competency, and knowledge, as well as the rapid progress in the US technologies.Currently, some US machines can be equipped by sophisticated software modalities (i.e., 3-dimensional US, elastosonography, automated cardiovascular software, and fusion imaging) that can augment US traditional role as a safe, fast, and easy-to-perform modality and giving it new life and increased relevance in rheumatology. In this article, we evaluated the US developments, from conventional B-mode to more sophisticated technologies, and their potential clinical impact in the field of rheumatology.Three-dimensional US can improve the accuracy of the assessment of bone erosions and the quantification of power Doppler because of its multiplanar view including coronal, axial and sagital view. Elastosonography is still looking for its role in rheumatology. Preliminary works induce us to consider it as a promise tool for the assessment of tendon pathology and skin of patients with connective tissue disorders. The automated method for the measurement of carotid intima-media thickness permits a rapid and accurate assessment. The preliminary published data showed that it is reliable, and valid compared to the traditional method; they also support the future of rheumatologists as the direct operators in evaluating the cardiovascular risk in daily practice. Fusion imaging increases the diagnostic power of US, displaying simultaneously in the monitor, the US image, and the corresponding computed tomography/magnetic resonance imaging image. However, there are no sufficient data supporting its application in daily rheumatologic practice.
Assuntos
Doenças Reumáticas , Reumatologia , Ultrassonografia/métodos , Precisão da Medição Dimensional , Humanos , Imageamento Tridimensional/métodos , Inflamação/diagnóstico , Invenções , Reprodutibilidade dos Testes , Doenças Reumáticas/diagnóstico , Doenças Reumáticas/fisiopatologia , Reumatologia/métodos , Reumatologia/tendênciasAssuntos
Humanos , Masculino , Feminino , Assistência Ambulatorial , Emergências , Doenças Reumáticas , Reumatologia/tendênciasRESUMO
UNLABELLED: Rheumatoid arthritis (RA) is a systemic inflammatory autoimmune disease causing significant social, medical, and economic impact. Several therapeutic regimens are available within the medical arsenal. The rational and reasoned use of various medications approved for their treatment is imperative. This study aimed to evaluate how Brazilian rheumatologists use the drugs available to combat the disease.For this, 128 Brazilian rheumatologists from public and private health services responded to an 18-item questionnaire, sent over the Internet, about different situations of drug treatment of RA. The answers helped to confirm the trends among Brazilian rheumatologists in the drug treatment of RA.The study results have shown that most Brazilian rheumatologists follow the guidelines and consensus established by the Brazilian Society of Rheumatology for the treatment of RA. A small proportion, however, start the biologic therapy in early stages of the disease, including the very early stage, as the first treatment option. Most experts use corticosteroids in low doses early in the treatment. CONCLUSIONS: This study confirms that the majority but not all Brazilian rheumatologists follow, in their daily practice, established guidelines and consensus for the treatment of RA. However, it also shows that some few rheumatologists start with anti-tumor necrosis factor therapy in very early arthritis independently of disease severity or prognostic factors.
Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Padrões de Prática Médica/tendências , Reumatologia/tendências , Adulto , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Inquéritos e Questionários , Adulto JovemRESUMO
Introdução: O conhecimento do perfil dos pacientes atendidos em um serviço médico é de fundamental importância para o planejamento de ações preventivas e curativas. As doenças reumáticas são reconhecidas pela cronicidade das queixas e grande morbidade que as acompanham, acarretando grande prejuízo em qualidade de vida e custo elevado para os sistemas de saúde. Objetivo: Verificar o perfil dos pacientes adultos atendidos no ambulatório de reumatologia do Complexo Hospitalar Santa Casa de Porto Alegre, RS. Métodos: Estudo ransversal descritivo, realizado através da aplicação de questionário na primeira consulta de pacientes atendidos no ambulatório de Reumatologia da Santa Casa, em período de seis meses. Resultados: Foram entrevistados 276 pacientes com média de idade de 52,5 anos, sendo 77,5% do sexo feminino e 56% procedentes de Porto Alegre. O tempo de ocorrência das queixas era de mais de um ano em 34,8% dos questionados, sendo que 12,7% tinham doença por tempo maior do que cinco anos. Trinta e quatro por cento dos pacientes já haviam buscado reumatologista previamente, sendo que 37,5% destes já haviam consultado cinco ou mais vezes pela mesma queixa. Médicos de outras especialidades foram procurados por 66%, sendo os traumatologistas os mais prevalentes (52%). Conclusão: Doenças articulares representam a segunda principal causa de incapacidade para o trabalho e o custo anual no atendimento desses pacientes repercute fortemente sobre os serviços de saúde. O investimento em políticas de saúde pública, com ações preventivas e curativas parte do conhecimento do perfil dos pacientes atendidos em determinado serviço de saúde.
Introduction: Knowledge of the profile of patients cared for at a medical service is critical for planning preventive and therapeutic strategies. Rheumatic diseases are known for the chronicity of complaints and associated high morbidity, leading to decreased quality of life for the patients and elevated costs for the health systems. Aim: To determine the profile of adults patients cared for at a rheumatology service of the Hospital Complex Santa Casa of Porto Alegre, RS. Methods: This is a descriptive cross-sectional study carried out through the application of a questionnaire responded by outpatients at their first visit to the above-mentioned rheumatology service during 6 months. Results: 276 patients (mean age = 52.5 years) were interviewed, of whom 77.5% were females and 56% lived in Porto Alegre. The reported beginning of complaints were older than one year among 34.8% of the sample, and 12.7% had the disease for longer than 5 years. 34% of the respondents had consulted with a rheumatologist in the past, and among these, 37.5% had already consulted five or more times because of the same complaint. Physicians of specialties other than rheumatology were consulted by 66% of the patients, traumatologists being the most prevalent ones (52%). Conclusion: Joint disorders are the second leading cause of disability for work, and the annual cost for caring for these patients exacts a heavy toll from health systems. The investment in public health policies, with preventive and therapeutic strategies, should start from knowledge of the profile of patients cared for at a particular health service.