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Abstract(s)
Introdução: Com a crescente incidência de neoplasias na população mundial urge uma maior compreensão dos efeitos secundários causados pelos tratamentos de quimioterapia como, por exemplo, na Reumatologia, área pouco explorada na literatura. Já foram relatadas diferentes manifestações musculoesqueléticas com vários fármacos de quimioterapia para distintas neoplasias. Os sintomas podem ocorrer mesmo com negatividade de achados radiológicos ou laboratoriais indicativos de doenças do foro reumatológico. Há algumas síndromes reumatológicas específicas descritas. Até à data, não existe uma explicação global destes fenómenos, apesar de algumas hipóteses terem sido colocadas. Neste contexto, fez-se um levantamento dos casos seguidos em consulta de Reumatologia e relacionou-se com a literatura existente.
Materiais e métodos: Trata-se de um estudo de investigação observacional, descritivo e clínico (relato de casos). Incluíram-se os pacientes com história de neoplasia e quimioterapia associada em seguimento atual em consulta de Reumatologia sem queixas reumatológicas prévias à quimioterapia. Excluíram-se aqueles com sintomas do foro reumatológico antes da neoplasia, assim como com queixas derivadas de metastização óssea ou síndromes paraneoplásicos. A caracterização da amostra teve por base os seguintes parâmetros: idade, sexo, tipo de neoplasia, tempo decorrido até aparecimento dos sintomas reumatológicos, apresentação clínica, resultados laboratoriais, tratamento reumatológico e evolução das queixas.
Resultados: Identificaram-se 6 casos clínicos de pacientes do sexo feminino, todas com antecedente de neoplasia da mama. Todas fizeram tratamento oncológico com inibidores da aromatase. Pouco tempo depois do início da terapêutica (entre 1 a 6 meses), surgiram sintomas do foro reumatológico em 5 pacientes, tendo a restante apresentado queixas num período de alguns meses a anos. Em nenhuma há registo de patologia reumatológica prévia ao tratamento de quimioterapia. As manifestações iniciais mais comuns foram artralgias com rigidez matinal que variava entre 5 minutos a uma hora e dores noturnas. As articulações mais afetadas foram as pequenas articulações das mãos. Em 5 doentes foram detetados anticorpos antinucleares positivos, sendo que uma destas tinha também anticorpo anti-Ro, anticorpo lúpico e fator reumatoide positivos. Nenhuma apresentava positividade para anticorpo anti-péptido citrulinado cíclico. A maioria obteve alívio com associações entre anti-inflamatórios não esteroides e/ou fármacos antirreumáticos modificadores de doença e/ou corticoides. Até à data nenhuma teve remissão espontânea da sintomatologia.
Conclusão: A patologia reumatológica pós-quimioterapia pode ter diversas formas de apresentação, desde artralgias inespecíficas, a artrite reumatoide, a síndromes específicas. Pode acompanhar-se ou não de achados laboratoriais positivos, tendo uma apresentação temporal variável e cujo controlo sintomático pode ser eficaz e rapidamente alcançado com medicação oral.
Introduction: With the increasing incidence of cancer in the world’s population, a greater understanding of side effects caused by chemotherapy treatments is urgently needed such as in Rheumatology, an area not much explored in the literature. Different musculoskeletal manifestations with various chemotherapy drugs have been reported for distinct types of cancer. Symptoms can occur even with negativity of radiologic or laboratory findings indicative of rheumatologic diseases. There are some specific syndromes described. To date, there is no comprehensive explanation of these phenomena, although some hypotheses have been considered. In this context, a survey of follow-up cases was performed in Rheumatology consultation and a comparison with the existing literature has been establish. Materials and methods: This is an observational, descriptive and clinical research study (case report). Patients with a history of cancer and associated chemotherapy were included if in current follow-up appointments and had no rheumatologic complaints prior to chemotherapy. Those with rheumatologic symptoms before cancer, as well as with complaints from bone metastasis or paraneoplastic syndromes were excluded. The characterization of the sample was based on the following parameters: age, sex, type of cancer, time to onset of rheumatologic symptoms, clinical presentation, laboratory results, rheumatologic treatment and evolution of complaints. Results: We identified 6 clinical cases of female patients, all with a history of breast cancer. All were in oncologic treatment with aromatase inhibitors. In 5 patients symptoms appeared soon after the beginning of therapy (between 1 and 6 months); the remain presented complaints in a period of months to years. In none, there was a registry of rheumatological pathology prior to chemotherapy. The most common manifestation was arthralgias with morning stiffness ranging from 5 minutes to 1 hour and night pain. The most affected joints were the small ones of the hands. In 5, positive antinuclear antibodies were detected; 1 also had positivity to anti-Ro antibodies, lupic antibody and rheumatoid factor. None had positive anti-cyclic citrullinated peptide antibody. Most patient's complaints were relieved by associations between non-steroidal anti-inflammatory drugs and/or disease modifying antirheumatic drugs and/or glucocorticoids. To date, none had spontaneous remission of symptoms. Conclusion: Rheumatologic pathology after chemotherapy may have several forms of presentation, from non-specific arthralgia, rheumatoid arthritis, to specific syndromes. It may or may not be accompanied by positive laboratory findings, with a variable temporal presentation and whose symptomatic control can be effectively and rapidly achieved with oral medication.
Introduction: With the increasing incidence of cancer in the world’s population, a greater understanding of side effects caused by chemotherapy treatments is urgently needed such as in Rheumatology, an area not much explored in the literature. Different musculoskeletal manifestations with various chemotherapy drugs have been reported for distinct types of cancer. Symptoms can occur even with negativity of radiologic or laboratory findings indicative of rheumatologic diseases. There are some specific syndromes described. To date, there is no comprehensive explanation of these phenomena, although some hypotheses have been considered. In this context, a survey of follow-up cases was performed in Rheumatology consultation and a comparison with the existing literature has been establish. Materials and methods: This is an observational, descriptive and clinical research study (case report). Patients with a history of cancer and associated chemotherapy were included if in current follow-up appointments and had no rheumatologic complaints prior to chemotherapy. Those with rheumatologic symptoms before cancer, as well as with complaints from bone metastasis or paraneoplastic syndromes were excluded. The characterization of the sample was based on the following parameters: age, sex, type of cancer, time to onset of rheumatologic symptoms, clinical presentation, laboratory results, rheumatologic treatment and evolution of complaints. Results: We identified 6 clinical cases of female patients, all with a history of breast cancer. All were in oncologic treatment with aromatase inhibitors. In 5 patients symptoms appeared soon after the beginning of therapy (between 1 and 6 months); the remain presented complaints in a period of months to years. In none, there was a registry of rheumatological pathology prior to chemotherapy. The most common manifestation was arthralgias with morning stiffness ranging from 5 minutes to 1 hour and night pain. The most affected joints were the small ones of the hands. In 5, positive antinuclear antibodies were detected; 1 also had positivity to anti-Ro antibodies, lupic antibody and rheumatoid factor. None had positive anti-cyclic citrullinated peptide antibody. Most patient's complaints were relieved by associations between non-steroidal anti-inflammatory drugs and/or disease modifying antirheumatic drugs and/or glucocorticoids. To date, none had spontaneous remission of symptoms. Conclusion: Rheumatologic pathology after chemotherapy may have several forms of presentation, from non-specific arthralgia, rheumatoid arthritis, to specific syndromes. It may or may not be accompanied by positive laboratory findings, with a variable temporal presentation and whose symptomatic control can be effectively and rapidly achieved with oral medication.
Description
Keywords
Artralgia Efeitos Adversos Inibidor da Aromatase Malignidade Quimioterapia