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Introdução: A Polimialgia Reumática é uma doença reumática inflamatória de etiologia desconhecida que se caracteriza por dor e rigidez das cinturas escapular e pélvica. Observa-se em pessoas com mais de 50 anos e as mulheres são tipicamente mais afectadas. Os marcadores inflamatórios mostram-se geralmente elevados e é característica uma resposta dramática aos corticoesteróides. Não existem testes de diagnóstico específicos, apenas um conjunto de critérios de classificação propostos em 2012, sendo fundamental a exclusão de outras doenças, como a Artrite Reumatóide e as neoplasias malignas. A Polimialgia Reumática relaciona-se com a Arterite de Células Gigantes. A Osteoporose é uma das possíveis complicações associadas à corticoterapia a longo prazo.
Objectivos: Pretende-se fazer a análise de uma coorte de doentes com Polimialgia Reumática, que incluirá a descrição da amostra, a verificação da aplicabilidade dos novos critérios de classificação e a caracterização da doença e da sua evolução. Realizar-se-á, também, uma investigação do risco de fractura osteoporótica. Os resultados obtidos serão discutidos e comparados com o que está descrito na literatura.
Material e Métodos: Este estudo é descritivo, observacional e retrospectivo. Consultaram-se os processos clínicos e electrónicos de 29 doentes seguidos em consultas de Reumatologia entre Março de 2010 e Dezembro de 2014. Foram analisadas e discutidas diversas variáveis, como os marcadores inflamatórios e as doses de corticoterapia utilizadas. Para a avaliação do risco de fractura osteoporótica utilizou-se o modelo FRAX®.
Resultados: A amostra caracteriza-se por uma idade média de 76 anos e 45% dos doentes do sexo feminino. Na apresentação, 83% queixava-se de dor ou rigidez da cintura escapular, 57% tinha dor ou rigidez na cintura pélvica e 36% referia rigidez matinal superior a 45 minutos. A velocidade de sedimentação e a proteína C reactiva encontravam-se inicialmente elevadas em 68% e 61% dos doentes, respectivamente. Todos os doentes apresentaram resposta favorável após o início da terapêutica. Em nenhum doente foi diagnosticada Arterite de Células Gigantes ou Artrite Reumatóide, tendo ocorrido um caso de Síndrome Paraneoplásica.
Discussão: Verificaram-se algumas variações face ao que está descrito na literatura. A reduzida dimensão da amostra consiste numa limitação importante relativamente à aplicabilidade dos resultados obtidos.
Conclusão: Os clínicos devem estar sensibilizados para esta condição que assume uma prevalência e impacto na qualidade de vida consideráveis. Será da maior relevância que se realizem mais estudos nesta área com amostras populacionais maiores, para que se possa compreender melhor esta entidade e abordá-la correctamente.
Introduction: Polymyalgia Rheumatica is a rheumatic inflammatory disease of unknown etiology characterized by pain and stiffness of the scapular and pelvic girdles. It is seen in people above 50 years old and women are typically more affected. Inflammatory markers are usually raised and a dramatic response to corticosteroids is characteristic. There are no specific diagnostic tests, only a set of classification criteria proposed in 2012, being fundamental the exclusion of other diseases, like Rheumatoid Arthritis and malignancy. Polymyalgia Rheumatica is related to Giant Cell Arteritis. Osteoporosis is one of the possible complications associated to long term therapy with steroids. Objectives: It is intended to do an analysis of a cohort of patients with Polymyalgia Rheumatica, which will include the description of the sample, the verification of the applicability of the new classification criteria and the description of the disease and its course. An investigation of the osteoporotic fracture risk will also be made. The obtained results will be discussed and compared with what is described in the literature. Material and Methods: This is a descriptive, observational and retrospective study. Clinical and electronic files of 29 patients followed in Rheumatology medical office visits between March 2010 and December 2014 were checked. Several variables, like inflammatory markers and the dosages of steroid therapy used, were analyzed and discussed. For the evaluation of de osteoporotic fracture risk it was used the FRAX® model. Results: The sample is characterized by a median age of 76 years and 45% of the patients belonging to the feminine genre. At presentation, 83% complained about pain or stiffness of the scapular girdle, 57% had pain or stiffness at the pelvic girdle and 36% referred morning stiffness superior to 45 minutes. Erythrocyte sedimentation rate and C-reactive protein were initially elevated in 68% and 61% of the patients, respectively. All the patients presented a favorable response after therapeutics initiation. None of the patients was diagnosed with Giant Cell Arteritis or Rheumatoid Arthritis, with one case of Paraneoplastic Syndrome been occurred. Discussion: Some variations concerning what is written in the literature have been verified. The reduced dimension of the sample is an important limitation regarding the applicability of the results obtained. Conclusion: Clinicians must be sensitized to this condition which assumes considerable prevalence and quality of life impact. Doing more studies in this area with bigger population samples would have the highest relevance, so that this entity could be better understood and correctly managed.
Introduction: Polymyalgia Rheumatica is a rheumatic inflammatory disease of unknown etiology characterized by pain and stiffness of the scapular and pelvic girdles. It is seen in people above 50 years old and women are typically more affected. Inflammatory markers are usually raised and a dramatic response to corticosteroids is characteristic. There are no specific diagnostic tests, only a set of classification criteria proposed in 2012, being fundamental the exclusion of other diseases, like Rheumatoid Arthritis and malignancy. Polymyalgia Rheumatica is related to Giant Cell Arteritis. Osteoporosis is one of the possible complications associated to long term therapy with steroids. Objectives: It is intended to do an analysis of a cohort of patients with Polymyalgia Rheumatica, which will include the description of the sample, the verification of the applicability of the new classification criteria and the description of the disease and its course. An investigation of the osteoporotic fracture risk will also be made. The obtained results will be discussed and compared with what is described in the literature. Material and Methods: This is a descriptive, observational and retrospective study. Clinical and electronic files of 29 patients followed in Rheumatology medical office visits between March 2010 and December 2014 were checked. Several variables, like inflammatory markers and the dosages of steroid therapy used, were analyzed and discussed. For the evaluation of de osteoporotic fracture risk it was used the FRAX® model. Results: The sample is characterized by a median age of 76 years and 45% of the patients belonging to the feminine genre. At presentation, 83% complained about pain or stiffness of the scapular girdle, 57% had pain or stiffness at the pelvic girdle and 36% referred morning stiffness superior to 45 minutes. Erythrocyte sedimentation rate and C-reactive protein were initially elevated in 68% and 61% of the patients, respectively. All the patients presented a favorable response after therapeutics initiation. None of the patients was diagnosed with Giant Cell Arteritis or Rheumatoid Arthritis, with one case of Paraneoplastic Syndrome been occurred. Discussion: Some variations concerning what is written in the literature have been verified. The reduced dimension of the sample is an important limitation regarding the applicability of the results obtained. Conclusion: Clinicians must be sensitized to this condition which assumes considerable prevalence and quality of life impact. Doing more studies in this area with bigger population samples would have the highest relevance, so that this entity could be better understood and correctly managed.
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Keywords
Arterite de Células Gigantes Artrite Reumatóide Corticoesteróides Osteoporose Polimialgia Reumática Síndrome Paraneoplásica