Brasil ResumoA artrite reumatoide é uma doença inflamatória auto-imune de distribuição mundial, sendo 2 a 3 vezes mais freqüente nas mulheres que nos homens. De etiologia desconhecida, afeta as articulações sinoviais periféricas, de forma simétrica e progressiva, levando à dor, edema articular e rigidez matinal. Quando não tratada, evolui com limitações funcionais graves. O propósito deste trabalho é descrever o perfil sociodemográfico, clínico-laboratorial e terapêutico dos pacientes com artrite reumatoide acompanhados em um ambulatório-escola de reumatologia, em Teresina-PI. Para tanto, desenvolveu-se um estudo retrospectivo com corte transversal observacional e abordagem quantitativa, analisando-se prontuários de pacientes portadores de artrite reumatoide, conforme formulário previamente elaborado no ambulatório de reumatologia da Clínica Escola de uma Instituição de Ensino Superior em Teresina-PI, durante o período de 2010 a 2014. Do total de 60 prontuários selecionados, 90% eram do sexo feminino. Os pacientes apresentaram uma idade média de 46,3 anos. A maior parte dos pacientes apresentou tempo de duração dos sintomas superior a um ano (63%). As principais articulações acometidas foram mãos (21,8%) e punhos (16,1%). As provas de atividade inflamatória mostraram-se alteradas ao diagnóstico (VHS 76,7% e PCR 55%). O fator reumatoide foi positivo em 23,3% dos pacientes e, apenas 13,3% realizaram anti-CCP. No tratamento predominou a associação do metotrexato com anti-maláricos, AINES, analgésicos ou corticóides. Concluiu-se que o presente estudo proporcionou uma visão parcial do perfil epidemiológico de pacientes com artrite reumatoide no estado do Piauí, identificando pontos importantes em relação às características demográficas e clínicas, os tipos de tratamentos farmacológicos e a pequena utilização de marcadores de doença. Descritores: Artrite Reumatoide; Fator Reumatoide; Terapêutica. AbstractThe Rheumatoid Arthritis is an auto-immune inflammatory disease of worldwide distribution and occurs 2 to 3 times more frequently in women than men. Of unknown etiology, it affects the peripheral synovial joints, symmetrically and progressively, leading to pain, joint edema and morning stiffness. If it is not treated evaluates to severe functional limitation. It was objectified describes the sociodemographic profile, the clinical-laboratory and the therapeutic of patients with Rheumatoid Arthritis (RA) followed in ambulatory school of rheumatology in Teresina-PI. It was developed a retrospective study with observational cross-cut and quantitative approach, analyzing medical records of patient RA carrier, according to formulary previously elaborated on clinical school of an Institution of Higher Education in Teresina-PI, during the period from 2010 to 2014. The total of 60 charts selected, 90% were females. Patients had a mean age of 46.3 years. The majority of patients had duration of symptoms longer than one year (63%). The main joints affected were hands (21.8%) and wrists (16.1%). The evidence of inflammatory activ...
Objectives: To develop an effective algorithm for the clinical management of osteoarthritis in the family health strategy, aiming to improve early diagnosis, appropriate treatment, and the quality of life of patients. Methods: Qualitative study where primary care physicians were invited to respond to a questionnaire regarding personal aspects of the professionals, as well as technical knowledge on the diagnosis and follow-up of osteoarthritis. Results: The profile of the general practitioner in Teresina's Family Health Strategy (ESF) is a younger professional (<50 years old), with more than 5 years of experience in primary care, who regularly undergoes scientific updates, and feels capable of diagnosing osteoarthritis using simple imaging exams. They identify the lack of health promotion programs and multidisciplinary teams as challenges in the diagnosis and follow-up of these patients. They consider projects aimed at health promotion for these patients and the development of osteoarthritis management protocols specifically for primary care to be of utmost importance. Conclusion: Due to the high incidence of referrals to specialists, it is of paramount importance to implement clinical management algorithms for osteoarthritis in primary care.
BACKGROUNDSpondylodiscitis is a term that covers the infectious involvement of the intervertebral body and disc. Infection can occur through hematogenous dissemination, contiguity of nearby tissues or direct contamination as occurs in surgical procedures. Diagnosis most often happens late as the initial symptoms are nonspecific, which is confused with mechanical spinal pain. This report describes a case of spondylodiscitis that evolved with areflex axial paraplegia, requiring decompressive laminectomy.
BACKGROUNDSpondylodiscitis is characterized by an infectious process of the intervertebral disc with the possibility of affecting adjacent areas, which can evolve with compression of nervous structures and determine neurological symptoms. The main route of transmission is hematogenous and is commonly associated with trauma, intravenous substances, hemodialysis and immunosuppression. The aim of this report is to present an advanced neurological condition of a patient with multiple comorbidities who was using corticosteroid at an immunosuppressive dose for chronic pain. CASE REPORTMSM, female, 60 years old, divorced, housewife, with hypertension and diabetes, former smoker, reported progressive paraparesis of the lower limbs with preserved sensitivity for 1 year, associated with moderate back pain, which made it difficult to perform daily tasks, showing partial improvement with the use of anti-inflammatory drugs and corticoids. She reported weight loss of 10 kg in this time interval and denied fever. One month before admission, the patient suffered a fall from a height of 1 m and evolved with paraplegia and urinary retention. In the initial tests, normocytic and normochromic anemia, leukocytosis with a left shift, elevated CRP and ESR, negative blood cultures and normal renal function were observed. Chest tomography showing lytic lesion in the thoracic vertebra, with compressive fractures of the vertebral bodies of T6, T7 and T8 and spine resonance showing perivertebral collections, determining medullary compression, suggestive of spondylodiscitis, with broad-spectrum antibiotic therapy being instituted. Bone scintigraphy with radiopharmaceutical uptake in the thoracic spine and costal arches. Normal total abdomen tomography; protein electrophoresis without monoclonal peak. Complementary investigation performed: negative tumor markers, unaltered breast and thyroid ultrasound, nonreactive PPD. The perivertebral abscess was drained, and the material was sent for cultures and histopathological analysis, which showed a negative result for neoplasm. The patient evolved with clinical and laboratory improvement, maintaining the neurological status. She was discharged for outpatient follow-up. CONCLUSIONIntervertebral disc infection can have an insidious course and, in many cases, it can present with severe manifestations. Thus, among the various causes of spondylodiscitis, prolonged use of corticosteroids may have influenced the severity of the condition, causing immunosuppression and the possibility of osteoporotic fractures.
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