Objective. To evaluate the efficacy of clofazimine (CFZ) compared with chloroquine diphosphate (CDP) for the treatment of cutaneous involvement in systemic lupus erythematosus (SLE).Methods. A prospective, randomized, controlled, double-blind clinical trial was carried out in SLE patients with active cutaneous lesions, of whom 16 were randomized to receive CFZ at 100 mg/day and 17 received CDP at 250 mg/day for 6 months. All drugs had a similar appearance to avoid identification. Both groups received broad-spectrum sunscreens twice a day and the prednisone dose was kept stable during the study. Cutaneous lesions were evaluated by 2 blinded observers at baseline and at months 1, 2, 4, and 6.Results. Thirty-three patients were randomized to a treatment group, of whom 27 completed 6 months of treatment. The groups were homogeneous and comparable in terms of demographic and clinical characteristics. Five CFZ-treated patients and 1 CDP-treated patient (P ؍ 0.15) dropped out due to development of severe lupus flare. At the end of the study, 12 CFZtreated patients (75%) and 14 CDP-treated patients (82.4%) had complete or near-complete remission of skin lesions; intention-to-treat analysis showed no significant difference in the response rates between groups. Side effects, mainly skin and gastrointestinal events, were frequent in both groups, but no patients had to discontinue their treatment.Conclusion. These findings suggest that CFZ is equally as effective as CDP in controlling cutaneous lesions in SLE patients. However, we cannot exclude the possibility that the CFZ itself could be the cause of systemic lupus flare. Lupus erythematosus (LE) is an autoimmune disease that can exclusively affect the skin (cutaneous LE [CLE]) or can affect other systems as well (systemic LE [SLE]). Cutaneous lesions are classified as either specific or nonspecific. Lupus-specific cutaneous lesions are divided into acute, subacute, and chronic. Acute CLE includes malar and generalized maculopapular rashes. Subacute CLE includes the annular-polycyclic and papulosquamous (psoriasiform) variants. Chronic CLE includes discoid lupus erythematosus, lupus profundus, and LE tumidus, among others. Of the nonspecific LE cutaneous lesions, Raynaud's phenomenon, bullous LE, and vasculitic lesions are most common (1-3).In the literature, there are no reports of controlled, randomized clinical trials of a treatment strategy for SLE patients with cutaneous lesions. Based on clinical experience, antimalarial drugs are considered to be the first option for treatment of these patients (4). When a safe dosage of antimalarial drugs is used, the side effects are rare and include retinopathy, corneal deposition, disturbance of visual accommodation, nausea, vomiting, urticaria, hair discoloration, skin and mucosal hyperpigmentation, headache, tinnitus, dizziness, and myopathy, among others (5,6). Unfortunately, not all SLE patients with cutaneous lesions show a good response to antimalarial drugs. Treatment of the refractory cases includes use of thalidomide...
-Rede Social. RESUMO Está claro na literatura que as Tecnologias de Informação e Comunicação (TICs
The objective of this study was to evaluate the early damage as measured by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR DI) in Brazilian systemic lupus erythematosus (SLE) patients with disease duration of 2 and 3 years and to evaluate the possible association between SLICC/ACR DI score and sociodemographic and clinical data. The SLICC/ACR DI was measured in 54 patients with SLE according to the ACR criteria for SLE and a mean (SD) disease duration of 29 (3.8) months. The patients were provided by outpatient clinics and hospitals of the public health network and private clinics in the city of Natal in Brazil. The SLICC/ACR DI scores for each type of organ damage, prevalence of damage within organ systems, and the association with sociodemographic variables were assessed. Disease duration was considered as the time from diagnosis until the study. Organ damage was present in 18 (33%) of the 54 patients while 36 patients (67%) had no damage. The skin (11%), renal (9%), and pulmonary (7.4%) systems were the most frequently involved, followed by the neuropsychiatric and musculoskeletal systems, premature gonadal failure, and diabetes. The most frequent individual items on the SLICC/ACR DI were scarring chronic alopecia and pleural fibrosis. No association was demonstrated between organ damage (SLICC/ACR scores) and sociodemographic and clinical variables. Early organ damage demonstrated in Brazilian patients with SLE was similar to other populations studied in the world, despite a low socioeconomic status. In contrast to reports in other studies, a cutaneous lesion was the most frequent cause of damage in our patients.
Artigo originAl originAl Article RESUMO Objetivo: Determinar a freqüência das manifestações clínicas e laboratoriais de pacientes com lúpus eritematoso sistêmico (LES) e identificar os danos precoces nos pacientes com diagnóstico recente. Métodos: Avaliação retrospectiva de 164 pacientes com LES do ambulatório de Reumatologia do Hospital Universitário Onofre Lopes -UFRN, de abril de 2003 a dezembro de 2004. As manifestações clínicas e laboratoriais avaliadas referem-se aos critérios de classificação do Colégio Americano de Reumatologia. A avaliação do índice de dano, através do SLICC/ACR DI
Background Despite the recent advances in the treatment of rheumatic diseases, especially if early diagnosed, it is already known that they are poorly recognized and managed by physicians in general, especially in primary care setting. Continuing medical education has been an alternative used in the rheumatology training for doctors. Regarding the specificities of rheumatology physical examination, real patients seemed to be the best option to facilitate the teaching-learning process in this area. Objectives To assess the confidence of physicians to recognize the rheumatic diseases, after participation in a workshop using active teaching methodology with real patients. Methods A practical workshop was conducted after a one-day scientific meeting in Natal-Brazil, focused in update general practitioners on more prevalent rheumatic diseases in primary care level. Forty five participants had an intensive practical training in osteoarthritis (OA), rheumatoid arthritis (RA), ankylosing spondylitis (AS) and back pain. The workshop was divided into three modules: 1-discussion of clinical cases, 2-training in physical examination with real patients, 3-radiological interpretation. Each module had a duration of 45 minutes and was led by 2-3 Rheumatology professors. Three groups of 15 participants were rotated among them. For the training of physical examination, there were selected 09 patients with OA, RA and AS at different stages of disease. Patients were informed about participation in the activity and signed the consent form. At the end, a questionnaire with a 5-point Likert scale was used to assess participants’ confidence and satisfaction with the teaching method employed. Results Twenty-two doctors and 11 medical students who completed the questionnaire, assessed the workshop as excellent (94%) or good (6%). Compared with the traditional method of lecture, respondents rated the method as “much more efficient” (76%) or “more efficient” (24%) for their learning process. They stated that the use of real patients to give them more intimacy with the symptoms and signs of the diseases studied had a very positive impact. For all participants, the confidence in the diagnosis of diseases covered by workshop has increased from one to three levels in the Likert scale used. Conclusions The use of active teaching methods with real patients proved to be a valid strategy in Rheumatology training for primary care physicians, enabling them to improved diagnosis and patient care. We expect that, in the future and after others effective interventions like this one, our patients would be refered to rheumatologists, if necessary, as early as possible. References Anne, B.; Debbie, M.; Sylvia, V.; Friedo, D.; Liesbeth, B.; Zuzana, Jong. Real patient learning integrated in a preclinical block musculoskeletal disorders. Does it make a difference? Clin Rheumatol. 2011 August; 30(8): 1029–1037. Bezerra, E.L.M.; Vilar, M.J.P.; Azevedo, G.D. Elective Rheumatology Program With A Primary Health Care Focus. Arthritis & Rheumatism. October 200...
Background Most of medical schools in Brazil still maintain a traditional discipline-based curriculum. In this context, a recent survey of medical students at clerkship in the UFRN, Natal, RN, Brazil, showed that current training is insufficient to meet the increasing educational demands for diagnosis and treatment in rheumatology. Objectives To develop a multidisciplinary longitudinal curriculum in rheumatology since the early undergraduate years, with progressive levels of complexity and integrating biomedical to clinical related contents. Methods During the last five years we started to insert “Rheumatology” as a longitudinal subject through our undergraduatecurriculum, with gradual levels of complexity. A faculty development program has been implemented for planning of insertion of rheumatology biomedical and clinical knowledge and skills in curriculum. The first contact with medical students is at the 1st year, when studentsare learning musculoskeletal anatomy/physiology and are introduced to clinical correlations focused in “soft tissue rheumatism”, as a way of basic-to-clinical integration. In the subsequent 2 years, learning activities are focused in development of semiological skills, including history-taking, physical examination and clinical reasoning. During the 4th year, students are introduced to most prevalent Rheumatology diseasesthrough theoretical and practical activities. Finally, in the medical clerkship (5th and 6th year), we have been the opportunity to discuss primary clinicalcases during the rotation of “Community Health” at a rural context. Additionally, inpatient and outpatient practices of connective tissue diseasesare experienced by students at the tertiary hospital setting. Results Overall, on the view of students, it is clear that these practices have contributed to their learning, giving meaning to the previously studied biomedical knowledge on musculoskeletal system. Internal institutional evaluation of rheumatology course pointed that students highly rated the faculty performance and their skills achievement. An external institutional evaluation performed by the Brazilian Ministry of Education also rated the UFRN medical course at maximum score (5,0). From the student view the main factors that facilitate learning in rheumatology were: basic-to-clinical integration (82.0%), small group discussions (66.7%), integration with community health (73.5%), carrying out practical activities (61.7%) and diversification of practice scenarios (44.4%), use of OSCE assessment in clerkship (76.2%). Conclusions Understanding the basic-to-clinical integration and promoting rheumatology learning in a diversity of scenarios are important strategies for the current medical education. Our experience with this teaching strategy has been effective and constitutes the basis for systematic and adequatetraining of students in musculoskeletal diseases. References Vilar M, Bezerra EM, Diniz RZ, Azevedo GD. Medical students’ self-assessed confidence in rheumatic diseases Ann Rheum Dis 2010; (Suppl3): 485...
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