RESUMO
Introduction: Rheumatoid arthritis is an autoimmune, chronic, and deforming condition associated with disability. Patients are immunosuppressed and at high risk of developing tuberculosis. The tuberculin skin test is used to screen candidates for biological therapy. Objective: To evaluate the frequency of positivity of the tuberculin skin test in a cohort of Colombian patients with rheumatoid arthritis. Materials and methods: We conducted a descriptive cross-sectional study including patients with rheumatoid arthritis receiving the tuberculin skin test prior to the start or at the time of the change of biological therapy. The patients' condition was moderate or severe and they were candidates for initiation or change of biological therapy. We defined the value of ≥6 mm as the cut-off point for a positive tuberculin skin test and performed a descriptive analysis for each of the variables considered. Results: In total, 261 patients with rheumatoid arthritis were included, 92 % of whom were women; the average age was 55 years (SD=13.92) and the time from diagnosis, 12.3 years (SD=8.54). The frequency of positive tuberculin skin tests was 15.71% (n=41). Of the 41 positive patients, nine had previously had the test (1 to 6 years before), all of them with negative results; 18 of these were receiving glucocorticoids (43.9%) and all of them (100%) were being treated with methotrexate. Conclusions: The frequency of positivity of the tuberculin skin test in these Colombian patients diagnosed with rheumatoid arthritis was around 16%. We reco0mmend optimizing strategies aimed at an optimal detection of this condition and the timely initiation of treatment to reduce the risk of tuberculosis reactivation.
Introducción. La artritis reumatoide es una enfermedad autoinmunitaria, crónica y deformante asociada con discapacidad. Quienes la padecen reciben inmunosupresores y tienen un gran riesgo de desarrollar tuberculosis. La prueba de intradermorreacción a la tuberculina se utiliza como tamización en quienes van a recibir terapia biológica. Objetivo. Evaluar la frecuencia de positividad en la prueba de intradermorreacción a la tuberculina en una cohorte de pacientes con artritis reumatoide. Materiales y métodos. Se hizo un estudio descriptivo de corte transversal de una cohorte de pacientes con artritis reumatoide a quienes se les practicó la prueba de tuberculina antes de iniciar la terapia biológica o en el momento del cambio de tratamiento. Los pacientes presentaban enfermedad moderada o grave y eran candidatos para iniciar o cambiar de terapia biológica. Se definió el valor de ≥6 mm como punto de corte para la positividad de la prueba y se hizo un análisis descriptivo de cada una de las variables. Resultados. Se incluyeron 261 pacientes con artritis reumatoide, 92 % de ellos eran mujeres, la edad promedio fue de 55 años (desviación estándar, DE=13,92) y el tiempo desde el diagnóstico era de 12,3 años (DE=8,54). La frecuencia de positividad de la prueba fue de 15,71 % (n=41). Nueve de los 41 pacientes positivos habían recibido la prueba previamente (entre 1 y 6 años antes), todos con resultado negativo; 18 (43,9 %) de ellos venían recibiendo tratamiento con glucocorticoides y todos los 41 (100 %) recibían metotrexate. Conclusiones. La frecuencia de positividad de la prueba de tuberculina en pacientes colombianos con artritis reumatoide fue de aproximadamente 16 %. Se recomienda optimizar las estrategias para detectar esta condición y darle un tratamiento oportuno y, así, disminuir el riesgo de reactivación de la tuberculosis.
Assuntos
Artrite Reumatoide , Tuberculose , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/tratamento farmacológico , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Tuberculina , Teste Tuberculínico , Tuberculose/diagnóstico , Tuberculose/epidemiologiaRESUMO
O termo artrite idiopática juvenil (AIJ) descreve um grupo clinicamente heterogêneo de artrites com mais de seis semanas de duração, de causa desconhecida e início até os 16 anos de idade. Objetivo: descrever o perfil clínico de um grupo de pacientes com diagnóstico de AIJ. Métodos: os prontuários de 72 indivíduos foram revistos com o objetivo de classificá-los conforme critérios propostos pelo ILAR. Os dados obtidos foram comparados com a literatura. Resultados: eram 37 crianças (51,4%) do sexo masculino e 35 do sexo feminino, com mediana de idade de 164,5 meses; 23 (31,9%) estavam classificados como sistêmicos, 25 (34,7%) como oligoarticulares, três (4,2%) poliarticulares fator reumatoide positivo, 13 (18,1%) poliarticulares fator reumatoide negativo, três (4,2%) com artrite psoriásica, quatro (5,6%) com artrite associada à entesite e um (1,4%) com doença indiferenciada. O fator reumatoide foi positivo em 10 (13,9%) e o FAN em 14 (19,4%). Uveíte crônica foi encontrada em quatro (5,6%) crianças, todas do sexo feminino (p=0,05), com doença iniciada antes dos quatro anos de idade (p=0,03) e com FAN positivo (p < 0,001). Conclusão: sabe-se que há diferenças na prevalência e na distribuição dos subtipos de AIJ dependendo da origem da população. Os dados analisados neste estudo, o primeiro do gênero em nosso país, indicaram importantes diferenças entre os diversos grupos geográficos/étnicos acometidos pela AIJ, sugerindo a influência de fatores genéticos, associados ou não a fatores ambientais, que deverão ser estudados e confirmados posteriormente, na expressão da AIJ.
The term Juvenile Idiopathic Arthritis (JIA) describes an arthritis clinically heterogeneous group of over six week?s duration, unknown causes and beginning up to 16 years old. Objective: to describe the clinic profile of a patients? group with JIA diagnosis. Methods: the records of 72 individuals were reviewed with the aim of classifying them according to the ILAR proposed criteria. The collected data were compared with the literature. Results: there was 37 male children (51,4%) and 35 female, with the mean age of 164,5 months; 23 (31,9%) were classified as systemic, 25 (34,7%) as oligoarticular, three (4,2%) as polyarticular positive rheumatoid factor, 13 (18,1%) polyarticular negative rheumatoid factor, three (4,2%) psoriatic arthritis, four (5,6%) with arthritis associated to enthesitis and one (1,4%) with indifferenced disease. The rheumatoid factor was positive in 10 (13,9%) and the FAN in 14 (19,4%). Chronic uveitis was found in four (5,6%) children, all female (p=0,05), with the disease started before four years old (p=0,03) and with positive FAN (p < 0,001). Conclusion: it is known that there are differences in the prevalence and distribution of the JIA subtypes depending on the population origins. The data analyzed in this study, the first of the kind in our country, indicate relevant differences between the several geographic / ethnical groups affected by the JIA, suggesting the influence of docugenetic factors, whether associated or not to environmental factors, which must be further studied and confirmed.