| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 733.76 KB | Adobe PDF |
Authors
Advisor(s)
Abstract(s)
Introdução: Os glucocorticoides (GC) têm um papel importante no tratamento de
várias doenças, nomeadamente nas doenças inflamatórias reumáticas. Apesar da sua
utilidade terapêutica, estes fármacos são uma causa importante de efeitos adversos como a
osteoporose induzida por glucocorticoides (GIOP). Embora seja uma complicação
clinicamente bem conhecida há vários anos, a GIOP permanece uma doença largamente
subdiagnosticada e, portanto, subtratada. Em 2017, a American College of Rheumatology
(ACR) publicou recomendações para a prevenção e tratamento da GIOP, sintetizando a
evidência científica sobre os benefícios e riscos da sua prevenção e opções de tratamento.
Em Portugal, não existem recomendações específicas para a prevenção e tratamento da
GIOP.
Objetivo: Avaliar as práticas de tratamento da GIOP nos doentes seguidos em
consulta de reumatologia na Unidade de Saúde Local da Guarda (ULSG).
Material e métodos: Realizou-se um estudo de coorte retrospetivo em doentes
seguidos em consulta externa de reumatologia na ULSG, entre 1 de junho de 2019 e 31 de
dezembro de 2019. Foram incluídos doentes com patologia inflamatória reumática, sob
terapêutica com GC durante =3 meses, numa dose =2,5mg/dia. A partir de registos clínicos,
recolheu-se dados sociodemográficos, clínicos e medidas implementadas de prevenção e
tratamento da GIOP. Com base nas recomendações da ACR de 2017, avaliou-se
individualmente a adequação do tratamento e identificaram-se os preditores de prescrição
de tratamento farmacológico.
Resultados: Dos 676 doentes seguidos em consulta de reumatologia naquele
período, 103 foram incluídos no estudo. A idade média amostra era de 60,9 (±13,3) anos e
68% eram do sexo feminino. Sete doentes tinham <40 anos, 1 dos quais foi considerado
como estando subtratado, segundo as recomendações da ACR de 2017. Dos 96 doentes com
=40 anos, 20,8% estavam adequadamente tratados e 40,6% subtratados. Nenhum doente
foi considerado sobretratado. Os fatores associados à prescrição farmacológica do
tratamento da GIOP foram a idade mais avançada, a maior probabilidade de fratura major
ou da anca, calculadas através do Fracture Risk Assessment Tool, e a história de fratura de
fragilidade. Os fatores determinantes da prescrição de tratamento eram uma pontuação
FRAX para fratura da anca =3% e um T-score de densidade mineral óssea vertebral <-2,1.
Conclusão: Tendo em conta as recomendações da ACR de 2017, uma grande
proporção de doentes com patologia inflamatória reumática medicados cronicamente com
GC estavam subtratados para a GIOP. Estas recomendações têm, no entanto, limitações na
sua aplicação à população portuguesa, sendo necessário criar orientações clínicas nacionais
para a prevenção e tratamento da doença.
Background: Glucocorticoids (GC) play an important role in the treatment of several conditions, including inflammatory rheumatic diseases. Despite their therapeutic utility, GC are associated with numerous adverse effects such as glucocorticoid induced osteoporosis (GIOP). Although it has been well recognized for several years, GIOP is still a largely underdiagnosed and, thus, undertreated condition. In 2017, the American College of Rheumatology (ACR) published guidelines for GIOP prevention and treatment, synthesizing the evidence for the benefits and harms of GIOP prevention and treatment options. In Portugal, there are no specific guidelines for the prevention and treatment of GIOP. Objectives: The aim of this study was to assess the current treatment practices of GIOP in patients followed in Rheumatology outpatient clinic in a secondary hospital. Materials and methods: A retrospective cohort study was conducted in patients followed in Rheumatology outpatient clinic between June 1st 2019 and December 31st 2019. Patients with inflammatory rheumatic disease under GC treatment for =3 months with a daily dosage of =2,5mg were included in the study. Sociodemographic, clinical and GIOP management data were obtained from clinical records. Using the 2017 ACR guidelines as reference, GIOP treatment adequacy was assessed and treatment prescription predictors were identified. Results: Of 676 patients followed in Rheumatology outpatient clinic in that period, 103 were included in the study. Patients’ mean age was 60,9 (±13,3) and 68% were female. Seven patients were <40 years old, one of which was considered undertreated according to ACR guidelines. Of the 96 patients =40 years old, 20,8% were adequately treated and 40,6% were undertreated. No patients were considered overtreated. Factors associated with GIOP treatment prescription were older age, higher major bone fracture or hip bone fracture risk obtained through Fracture Risk Assessment Tool and previous bone fragility fracture. A FRAX score for hip fracture =3% and a vertebral bone mineral density T-score <-2,1 were identified as prescription determinants of pharmacological treatment. Conclusion: Following the 2017 ACR guidelines, a large proportion of patients with inflammatory rheumatic disease chronically treated with GC were undertreated for GIOP. There are, however, limitations in these guidelines application to the Portuguese population which emphasize the need to develop national clinical recommendations for the prevention and treatment of GIOP.
Background: Glucocorticoids (GC) play an important role in the treatment of several conditions, including inflammatory rheumatic diseases. Despite their therapeutic utility, GC are associated with numerous adverse effects such as glucocorticoid induced osteoporosis (GIOP). Although it has been well recognized for several years, GIOP is still a largely underdiagnosed and, thus, undertreated condition. In 2017, the American College of Rheumatology (ACR) published guidelines for GIOP prevention and treatment, synthesizing the evidence for the benefits and harms of GIOP prevention and treatment options. In Portugal, there are no specific guidelines for the prevention and treatment of GIOP. Objectives: The aim of this study was to assess the current treatment practices of GIOP in patients followed in Rheumatology outpatient clinic in a secondary hospital. Materials and methods: A retrospective cohort study was conducted in patients followed in Rheumatology outpatient clinic between June 1st 2019 and December 31st 2019. Patients with inflammatory rheumatic disease under GC treatment for =3 months with a daily dosage of =2,5mg were included in the study. Sociodemographic, clinical and GIOP management data were obtained from clinical records. Using the 2017 ACR guidelines as reference, GIOP treatment adequacy was assessed and treatment prescription predictors were identified. Results: Of 676 patients followed in Rheumatology outpatient clinic in that period, 103 were included in the study. Patients’ mean age was 60,9 (±13,3) and 68% were female. Seven patients were <40 years old, one of which was considered undertreated according to ACR guidelines. Of the 96 patients =40 years old, 20,8% were adequately treated and 40,6% were undertreated. No patients were considered overtreated. Factors associated with GIOP treatment prescription were older age, higher major bone fracture or hip bone fracture risk obtained through Fracture Risk Assessment Tool and previous bone fragility fracture. A FRAX score for hip fracture =3% and a vertebral bone mineral density T-score <-2,1 were identified as prescription determinants of pharmacological treatment. Conclusion: Following the 2017 ACR guidelines, a large proportion of patients with inflammatory rheumatic disease chronically treated with GC were undertreated for GIOP. There are, however, limitations in these guidelines application to the Portuguese population which emphasize the need to develop national clinical recommendations for the prevention and treatment of GIOP.
Description
Keywords
Reumatologia Densidade Mineral
Óssea Doenças Inflamatórias Frature Risk Assessment Tool Glucocorticoides Osteoporose Osteoporose Induzida Por Glucocorticoides