Medicina

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Avaliação da qualidade de vida dos pacientes com lúpus eritematoso sistêmico juvenil atendidos no ambulatório de reumatologia pediátrica do Centro Universitário do Estado do Pará
(Centro Universitário do Estado do Pará, 2020) Nascimento, Igor Tadeu de Castro; Nascimento, Jéssyca Cristina Ramos do; Cavalcante, Erica Gomes do Nascimento
Introduction. Juvenile Systemic Lupus Erythematosus (JSLE) is a chronic condition characterized by loss of immunoregulatory control during the disease activity. The most prevalent JSLE clinical manifestations are on females, in the pediatric age. The high incidence of disease damage are related to lower quality of life, besides to the physical, psychosocial and school negative repercussions secondary to the health situation. Objectives. To evaluate the impact of JSLE on the quality of life in patients under follow-up at the pediatric rheumatology outpatient clinic of CESUPA. Methods. The survey was in three phases. The first phase had an exploratory documentary analysis, to identify patients diagnosed with JSLE according to the SLICC criteria. In the second phase, a cross-seccional study was conducted, using PedsQLTM 4 questionnaire for patients and parents and guardians, to evaluate the health-related quality of life. The last phase, the SLEDAI-2K and SLICC/ACR-DI indices were used to score disease activity and cumulative damages. Results. A good quality of life, according to PedsQLTM 4, are present in most patients of this study. The was no direct relationship between the SLICC/ACR-DI score evaluate in the last outpatient clinic follow-up and the improvement of the quality of life. The same thing happened when comparing with the SLEDAI-2K score; in the latter, among the patients with low disease activity, there were 1/3 with low HRQoL, while 2/3 presented high HRQoL. In relating HRQoL to time diagnosis, was observed a better quality of life in patients who had a shorter time since diagnosis. In isolated evaluation of quality of life, the social and physical domains had higher score than emotional domain. For parents and guardians, among children, the social and school aspects had the higher averages and the emotional aspect lower avarages. On the other hand, among adolescents, the social e physical domains had higher avarages. Both children and adolescents had higher SLEDAI-2K on the first appointment. The children compared to adolescents, had higher SLEDAI-2K on the first appointment and lower on the last appointment. The most frequent clinical manifestations on the first appointment were arthritis, alopecia and seizure, in SLEDAI-2K; and the laboratory manifestations was a decrease in the complement system and anti-dna, besides proteinuria. The majority of patients had no score on cumulatives damages - there were only 38,8%. Clinical and laboratory manifestations were varied on SLICC criteria for diagnosis on the first appointment. Demographically, there was female prevalence and brown skin color among patients; the majority diagnosis was in childhood. Conclusion. For patients, JSLE has a greater emotional impact. For parents and guardians, on the other hand, the emotional impact is greater only on children; and school impact is greater on adolescents. The damages had no impact on HRQoL and the disease activity decreased during course of the illness.
Estudo clínico e imunológico comparativo do acometimento inicial e desfecho de pacientes com lúpus eritematoso sistêmico juvenil e adulto
(Centro Universitário do Estado do Pará, 2021) Araújo, Andreia Ximendes de; Tavares, Vitória Santos da Silva; Cavalcante, Erica Gomes do Nascimento; Lima, Glauce Leão; http://lattes.cnpq.br/7526159894502830; http://lattes.cnpq.br/6296398919595807
Introduction: Systemic Lupus Erythematosus (SLE) is an autoimmune rheumatic disease, with a chronic character and large clinical spectrum. It results from complex abnormalities of the immune system, with the predominance of antinuclear antibodies that affect several organs and systems. It affects both genders, at any age, however, has a higher incidence in women in reproductive age, with a peak at 30 years. In some cases, it can manifest in the juvenile age group (JSLE). However, considering the diagnosis and the different prevalent clinical manifestations from SLE and JSLE, articles on this subject are still not common, making it difficult to create a profile that comprises the higher severity of symptoms manifested before the age of eighteen in comparison with LES. Objectives: to identify differences in the clinical, epidemiological, and immunological profile of patients that fulfilled the criteria for classification of Systemic Lupus Erythematosus and Juvenile Systemic Lupus Erythematosus, under follow-up at the Pediatric Rheumatology and Rheumatology ambulatory of the Cesupa Medical Specialties Center (CEMEC). Method: a retrospective, descriptive and observational longitudinal study of the historical cohort type was carried out, with a qualitative and quantitative approach. The study was carried out at the Medical Specialties Center (CEMEC) of the Centro Universitário do Pará (CESUPA), located in Belém-PA. Results: both groups had a predominance of females composing the sample. The most frequent clinical manifestations in JSLE were fever, asthenia, acute skin manifestations, arthralgia, vasculitis, pericardial effusion, proteinuria, hematic cylinders, lupus nephritis, lymphopenia, thrombocytopenia and hypocomplementenemia. Adult group patients hadat the beginning and follow-up, predominance of increased values in inflammatory tests, weight loss, papulosquamous cutaneous lupus, scarring and nonscarring alopecia, oral ulcers, arthritis, pericarditis, pleural effusion, transverse myelitis, neuritis and psychosis, hemolytic anemia autoimmune, leukopenia and neutropenia. The juvenile group had a higher index of activity at the beginning of the disease, however, it had a more favorable development when compared to the adult group, since its SLEDAI-2K index decreased more effectively than the group of adult onset. Conclusion: JSLE patients had slightly higher prevalence in males, anti-dsDNA antibody positivity, hypocomplementenemia, higher frequency of acute skin manifestations, renal involvement and higher disease activity index at the beginning, but with better progress in its course. SLE obtained female prevalence, laboratory manifestations of autoimmune hemolytic anemia and leucopenia, in addition to higher inflammatory activity and joint symptoms.
Perfil clínico e epidemiológico de pacientes pediátricos portadores de febre reumática atendidos em um Centro de Especialidades Médicas do Pará
(Centro Universitário do Estado do Pará, 2021) Azevedo, Camila Pantoja; Lima, Gabriela Elenor dos Santos; Cavalcante, Erica Gomes do Nascimento; http://lattes.cnpq.br/6296398919595807
Introduction: Rheumatic fever consists of a non-suppurative inflammatory process resulting from an immune response to pharyngotonsillitis caused by beta-hemolytic A streptococcus and affects mainly developing countries. Arthritis is the most common clinical manifestation, followed by carditis, which is the manifestation of the worst prognosis, fever is a common symptom at the beginning of the acute condition. The diagnosis is based on the Jones criteria, requiring the presence of two major criteria or one major and two minor criteria. The main way to avoid its complications is through prophylaxis with benzathine penicillin G lasting for years, varying according to the degree of involvement. Objective: To analyze the clinical and epidemiological profile of pediatric patients with rheumatic fever in a Center of Medical Specialties in Pará. Method: An observational, cross-sectional, descriptive study was carried out, with a quantitative assessment of 17 medical records of patients with rheumatic fever at the Pediatric Rheumatology outpatient clinic from January 2017 to October 2020. Results: Patients with rheumatic fever correspond to 5.10% of the total number of patients attended at the Pediatric Rheumatology outpatient clinic. Of the total, 10 patients were male and 7 female. In addition, 10 were 10 years old or older. As for socioeconomic conditions, 70.6% lived in a brick house, and this same percentage lived in an urban area and 47.1% had a family income equal to or less than 1 minimum wage. No patient reported similar cases in the family. As for clinical manifestations, fever was found in 88.2% of cases, arthritis in 58.8%, mild carditis in 47.1%, Syndeham's chorea in 35.3%, erythema marginatum in 35.3%, migratory arthralgia in 29.4% and subcutaneous nodules in 29.4%. Also, 58.8% arrived at the clinic with the diagnosis. The most frequent reasons for referral were rheumatic fever (7), carditis (5) and Syndeham's chorea (5). The most requested initial exams were blood count (13), ESR (13), PCR (13) and ASLO (12). After starting follow-up at the outpatient clinic, 100% of the patients received treatment with benzathine penicillin G. Conclusion: In this research, mainly male, brown patients, from the countryside and with an average age of 10 years, were affected. The most common clinical manifestations were fever, carditis and arthritis. The most requested initial tests were blood count, ESR, CRP and ASLO and the median time between the first manifestation and the diagnosis was 2 months. Five patients interrupted prophylaxis with benzathine penicillin G and two patients presented recurrence.

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