RESUMO
Considerable variability exists in the way that health-care providers treat patients with giant cell arteritis in Latin America, with patients commonly exposed to excessive amounts of glucocorticoids. In addition, large health disparities prevail in this region due to socioeconomic factors, which influence access to care, including biological treatments. For these reasons, the Pan American League of Associations for Rheumatology developed the first evidence-based giant cell arteritis treatment guidelines tailored for Latin America. A panel of vasculitis experts from Mexico, Colombia, Peru, Brazil, and Argentina generated clinically meaningful questions related to the treatment of giant cell arteritis in the population, intervention, comparator, and outcome (PICO) format. Following the grading of recommendations, assessment, development, and evaluation methodology, a team of methodologists did a systematic literature search, extracted and summarised the effects of the interventions, and graded the quality of the evidence. The panel of vasculitis experts voted on each PICO question and made recommendations, which required at least 70% agreement among the voting members to be included in the guidelines. Nine recommendations and one expert opinion statement for the treatment of giant cell arteritis were developed considering the most up-to-date evidence and the socioeconomic characteristics of Latin America. These recommendations include guidance for the use of glucocorticoids, tocilizumab, methotrexate, and aspirin for patients with giant cell arteritis.
Assuntos
Arterite de Células Gigantes , Reumatologia , Humanos , Arterite de Células Gigantes/tratamento farmacológico , Argentina , Aspirina , Brasil , Glucocorticoides/uso terapêuticoRESUMO
ANCA-associated vasculitides (AAV) comprise three diseases: granulomatosis with polyangiitis, microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis. They are characterised by small vessel inflammation and have a broad range of clinical manifestations and multiorgan involvement which endanger the patient's life. An increasingly recognised complication of AAV, especially in MPA is lung fibrosis, for which no clearcut therapy in this context is available. The release of neutrophil extracellular traps (NETs) in these diseases has been related to the development of fibrosis, but the precise mechanisms are not fully unravelled. This review provides an overview of some of the important proteins known to compose NETs, and proposes some mechanisms by which these remarkable components may exert an impact on the different fibroblastic phenotypes leading to lung fibrosis.
Assuntos
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos , Síndrome de Churg-Strauss , Armadilhas Extracelulares , Granulomatose com Poliangiite , Poliangiite Microscópica , Fibrose Pulmonar , Anticorpos Anticitoplasma de Neutrófilos , Fibroblastos , Humanos , Fibrose Pulmonar/etiologiaRESUMO
Microscopic polyangiitis (MPA) frequently involves the lungs. However, as opposed to granulomatosis with polyangiitis (Wegener's), limited forms are not recognised. In recent years, cases have been reported in which the lungs were affected without other organ manifestations. For years, many have been labelled as idiopathic pulmonary fibrosis (IPF). In this review, support for the existence of a limited form of MPA affecting the lungs as well as questions and discussions concerning the similarities and differences to IPF are offered.