RESUMO
OBJECTIVE: In systemic lupus erythematosus (SLE), disease activity and glucocorticoid (GC) exposure are known to contribute to irreversible organ damage. We aimed to examine the association between GC exposure and organ damage occurrence. METHODS: We conducted a literature search (PubMed (Medline), Embase and Cochrane January 1966-October 2021). We identified original longitudinal observational studies reporting GC exposure as the proportion of users and/or GC use with dose information as well as the occurrence of new major organ damage as defined in the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index. Meta-regression analyses were performed. Reviews, case-reports and studies with <5 years of follow-up, <50 patients, different outcomes and special populations were excluded. RESULTS: We selected 49 articles including 16 224 patients, 14 755 (90.9%) female with a mean age and disease duration of 35.1 years and of 37.1 months. The mean follow-up time was 104.9 months. For individual damage items, the average daily GC dose was associated with the occurrence of overall cardiovascular events and with osteoporosis with fractures. A higher average cumulative dose adjusted (or not)/number of follow-up years and a higher proportion of patients on GC were associated with the occurrence of osteonecrosis. CONCLUSIONS: We confirm associations of GC use with three specific damage items. In treating patients with SLE, our aim should be to maximise the efficacy of GC and to minimise their harms.
Assuntos
Glucocorticoides , Lúpus Eritematoso Sistêmico , Feminino , Glucocorticoides/efeitos adversos , Humanos , Incidência , Estudos Longitudinais , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/epidemiologia , Estudos Observacionais como Assunto , Análise de RegressãoRESUMO
OBJECTIVE: The Lupus Foundation of America Rapid Evaluation of Activity in Lupus (LFA-REAL) clinician-reported outcome (ClinRO) and the LFA-REAL patient-reported outcome (PRO) were developed in order to capture manifestations of SLE from the perspective of both the clinician and the patient. The aim of this study is to compare the LFA-REAL ClinRO and PRO with other lupus disease activity measures. METHODS: A cross-sectional analysis of patients from a single-centre cohort was performed using Spearman's correlation. Disease activity measures included were LFA-REAL ClinRO (range 0-1400), LFA-REAL PRO (range 0-1200), Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K), clinical SLEDAI-2K and Physician Global Assessment (PGA, range 0-100). RESULTS: Two hundred and twenty-seven patients with SLE were studied. The mean age was 46.3 (SD: 13.8); 212 (93.4%) were female. The mean (SD) LFA-REAL ClinRO was 25.4 (34.7), LFA-REAL PRO was 241.1 (187.6), PGA was 11.9 (15.4), SLEDAI-2K was 2.3 (3.3) and clinical SLEDAI-2K was 1.6 (2.9). The LFA-REAL ClinRO correlated with PGA (r=0.758, p<0.001), SLEDAI-2K (r=0.608, p<0.001) and clinical SLEDAI-2K (r=0.697, p<0.001); the LFA-REAL PRO correlated modestly with PGA (r=0.160, p=0.016), SLEDAI-2K (r=0.121, p=0.069), clinical SLEDAI-2K (r=0.143, p=0.031) and LFA-REAL ClinRO (r=0.161, p=0.015). CONCLUSIONS: The LFA-REAL ClinRO and the LFA-REAL PRO had good and weak correlations, respectively, with several physician-based disease activity measures in a cross-sectional study, suggesting their potential usefulness in establishing disease severity. Longitudinal studies will be required to determine their value in monitoring patients with SLE.
Assuntos
Lúpus Eritematoso Sistêmico , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Peru , Índice de Gravidade de DoençaRESUMO
La coagulación con argón-plasma es una terapia efectiva para pacientes con hemorragia digestiva superior por patologías como angiodisplasias y úlceras pépticas con vaso visible. El uso de esata terapia para hemorragias inducidas por Esfinterotomía Endoscópica (E.E) no ha sido reportado anteriormente. Se presentan 5 pacientes con sangrado inmediato, pulsátil, profuso, que ocupaba toda el área papilar, a quienes se les realizó compresión con balón de Fogarty sin lograr hemostasia, por lo que se aplicó argon-plasma utilizando una unidad Erbe APC 300. Se logró detener el sangrado en los 5 pacientes (100 por ciento). No hubo resangrado, complicaciones inmediatas del procedimiento ni necesidad de tratamiento quirúrgico en estos pacientes. El obejtivo del presente trabajo es mostrar la experiencia inicial utilizando argón-plasma en pacientes con sangrado post-E.E. que no respondan a otra medida terapéutica como compresión con balón. Pensamos que este procedimiento pudiera ser una alternativa endoscópica después del fallo de la terapia de esclerosis y/o taponamiento con balón para el control de la hemorragia post E.E., antes de decidir realizar angiografía o tratamiento quirúrgico
Assuntos
Humanos , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Argônio , Endoscopia , Esfinterotomia Endoscópica , Gastroenterologia , VenezuelaRESUMO
La coagulación con Argón-Plasma (APC) has sido utilizada durante años para producir hemostasia en la cirugía abierta, siendo incorporada a la endoscopia en 1994. Es una técnica electroquirúrgica monopolar sin contacto, inicialmente fue introducida para el tratamiento paliativo de neoplasia, pero se ha venido ampliando la indicación para su uso en otras patologías de las vías digestivas. El objetivo del presente trabajo es mostrar la experiencia inicial en Venezuela con este novedoso método, analizando variables como el número de sesiones, el grado de recurrencia y la morbi-mortalidad en estos pacientes. Durante un período de 23 meses se realizó terapia con APC en 95 pacientes, las indicaciones para el procedimiento fueron: angiodisplasias (n=39), úlceras sangrantes (N=8), ablación de pólipos (n=22), rectitis actínica (n=6), ablación de tumores de esófago (n=2), otras. Se utilizó un equipo de Argón APC 300 marca ERBE acoplado a un generador electroquirúrgico ICC 200 son ondas flexibles de 2,5 mm. No hubo complicaciones ni muertes a los pacientes sometidos a esta terapéutica endoscópica. La experiencia inicial indica que el APC parece ser una terapia efectiva y segura en un amplio rango de patologías gastrintestinales