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Abstract(s)
Introdução: A osteoporose caracteriza-se pela redução da densidade mineral óssea,
alteração da microarquitetura e resistência ósseas e aumento do risco de fraturas vertebrais
e não-vertebrais. A artrite reumatóide e a terapêutica prolongada com corticóides são
fatores de risco para a osteoporose. O exame utilizado, para o diagnóstico da osteoporose é
a absorciometria radiológica de dupla energia, que quantifica a densidade mineral óssea.
Apesar de não existir um consenso universal, segundo as guidelines da Associação
Americana de Endocrinologistas Clínicos e da Direção Geral de Saúde, em doentes com
artrite reumatóide devemos proceder à realização periódica da absorciometria radiológica
de dupla energia, com um intervalo de 24 meses. Estas indicações têm como objetivo o
diagnóstico precoce da osteoporose e o acompanhamento da evolução após instituição da
terapêutica.
Objetivos: Identificar os doentes com artrite reumatóide e osteoporose do serviço de
Reumatologia do Hospital Amato Lusitano. Verificar o cumprimento das guidelines quanto
à realização da absorciometria radiológica de dupla energia: inicial e repetição ao fim de 24
meses.
Métodos: Realizou-se um estudo retrospetivo, englobando os utentes seguidos na consulta
externa de Reumatologia do Hospital Amato Lusitano, com o diagnóstico de artrite
reumatóide codificado entre março de 2011 e dezembro de 2017. Foram incluídos 118
doentes e os dados foram recolhidos através da consulta dos processos clínicos. A análise
estatística foi realizada com recurso ao Statistical Package for the Social Sciences, versão
25, com um nível de significância a definido a 0.05.
Resultados: Da amostra de 118 doentes com artrite reumatóide, 33,1% foram
diagnosticados com osteoporose. O Cálcio e/ou Vitamina D foi o tratamento mais prescrito
em 86,4% (n=102) dos doentes, seguido dos bifosfonatos em 29,7% (n=35) e o denosumab
em apenas 4,2% (n=5) dos doentes. A maioria dos doentes realizou absorciometria
radiológica de dupla energia ao diagnóstico (78,0%; n=92), mas esta só foi repetida em
28,0% (n=33) dos casos. O tempo médio para a repetição da absorciometria radiológica de
dupla energia foi de 50,9 meses e apenas 5,1% repetiram em até 2 anos.
Conclusão: As guidelines para realização da absorciometria radiológica de dupla energia
não estão a ser alcançadas. Os doentes que não são respondedores ao tratamento antiosteoporótico poderão não estar a ser identificados e, com isso, poderão incorrer num risco
aumentado de fratura. Os resultados deste trabalho permitirão aumentar a vigilância
daqueles doentes sobre a necessidade de repetição do exame de forma que o tratamento
anti-osteoporótico seja eficaz. Será importante entender quais os motivos por detrás desta
situação e tentar encontrar soluções.
Introduction: Osteoporosis is characterized by the reduction in bone mineral density, the alteration of bone microarchitecture and resistance, as well as the increased risk of vertebral and non-vertebral fractures. Rheumatoid arthritis and long-term therapy with corticoids are risk factors for osteoporosis. The test used for the diagnosis of osteoporosis is dual energy X-ray absorptiometry, which quantifies bone mineral density. Although there is no universal consensus, according to the guidelines of the American Association of Clinical Endocrinologists and the General Directorate of Health (Direção Geral de Saúde), patients with rheumatoid arthritis should be submitted to a periodic dual energy X-ray absorptiometry, with an interval of 24 months. The purpose of these indications is to obtain an early diagnosis of osteoporosis and provide follow-up on its evolution once therapy is initiated. Objectives: To identify patients with rheumatoid arthritis and osteoporosis at the Rheumatology Service at Amato Lusitano Hospital. To verify the compliance with the guidelines regarding the performance of dual energy X-ray absorptiometry: the initial one and the one repeated after 24 months. Methods: A retrospective study was carried out, involving patients who were being treated at the outpatient Rheumatology service at the Amato Lusitano Hospital, with the diagnosis of rheumatoid arthritis, coded between March 2011 and December 2017. 118 patients were included and the data were collected through consultation of clinical processes. Statistical analysis was performed using the Statistical Package for the Social Sciences, version 25, with an a significance level set at 0.05. Results: Of the sample of 118 patients with rheumatoid arthritis, 33.1% were diagnosed with osteoporosis. Calcium and / or Vitamin D was the most prescribed treatment in 86.4% (n = 102) of patients, followed by bisphosphonates in 29.7% (n = 35) and denosumab in only 4.2% (n = 5) of patients. Most patients underwent dual energy X-ray absorptiometry at diagnosis (78.0%; n = 92), but this was only repeated in 28.0% (n = 33) of the cases. The average time for dual energy X-ray absorptiometry repetition was 50.9 months and only 5.1% repeated it in up to 2 years. Conclusion: The guidelines for performing dual energy X-ray absorptiometry are not being achieved. Patients who are not responding to anti-osteoporotic treatment are possibly not being identified and, as a result, may be at increased risk of fracture. The results of this work will increase the observation of those patients, alerting about the need to repeat the exam in order for the anti-osteoporotic treatment to be effective. It will be important to understand the reason behind this situation and try to find solutions.
Introduction: Osteoporosis is characterized by the reduction in bone mineral density, the alteration of bone microarchitecture and resistance, as well as the increased risk of vertebral and non-vertebral fractures. Rheumatoid arthritis and long-term therapy with corticoids are risk factors for osteoporosis. The test used for the diagnosis of osteoporosis is dual energy X-ray absorptiometry, which quantifies bone mineral density. Although there is no universal consensus, according to the guidelines of the American Association of Clinical Endocrinologists and the General Directorate of Health (Direção Geral de Saúde), patients with rheumatoid arthritis should be submitted to a periodic dual energy X-ray absorptiometry, with an interval of 24 months. The purpose of these indications is to obtain an early diagnosis of osteoporosis and provide follow-up on its evolution once therapy is initiated. Objectives: To identify patients with rheumatoid arthritis and osteoporosis at the Rheumatology Service at Amato Lusitano Hospital. To verify the compliance with the guidelines regarding the performance of dual energy X-ray absorptiometry: the initial one and the one repeated after 24 months. Methods: A retrospective study was carried out, involving patients who were being treated at the outpatient Rheumatology service at the Amato Lusitano Hospital, with the diagnosis of rheumatoid arthritis, coded between March 2011 and December 2017. 118 patients were included and the data were collected through consultation of clinical processes. Statistical analysis was performed using the Statistical Package for the Social Sciences, version 25, with an a significance level set at 0.05. Results: Of the sample of 118 patients with rheumatoid arthritis, 33.1% were diagnosed with osteoporosis. Calcium and / or Vitamin D was the most prescribed treatment in 86.4% (n = 102) of patients, followed by bisphosphonates in 29.7% (n = 35) and denosumab in only 4.2% (n = 5) of patients. Most patients underwent dual energy X-ray absorptiometry at diagnosis (78.0%; n = 92), but this was only repeated in 28.0% (n = 33) of the cases. The average time for dual energy X-ray absorptiometry repetition was 50.9 months and only 5.1% repeated it in up to 2 years. Conclusion: The guidelines for performing dual energy X-ray absorptiometry are not being achieved. Patients who are not responding to anti-osteoporotic treatment are possibly not being identified and, as a result, may be at increased risk of fracture. The results of this work will increase the observation of those patients, alerting about the need to repeat the exam in order for the anti-osteoporotic treatment to be effective. It will be important to understand the reason behind this situation and try to find solutions.
Description
Keywords
Absorciometria Radiológica de Dupla Energia Artrite Reumatóide Guidelines Osteoporose T-Score