Educomunicação, Transformação Social e Desenvolvimento Sustentável

Esta publicação apresenta os principais trabalhos dos GTs do II Congresso Internacional de Comunicação e Educação nos temas Transformação social, com os artigos que abordam principalmente Educomunicação e/ou Mídia-Educação, no contexto de políticas de diversidade, inclusão e equidade; e, em Desenvolvimento Sustentável os artigos que abordam os avanços da relação comunicação/educação no contexto da educação ambiental e desenvolvimento sustentável

The Anti-TNF-α Therapy in the Rheumatoid Arthritis <br> A Terapia Anti-TNF-α na Artrite Reumatóide

Rheumatoid arthritis is a chronic, systemic autoimmune disease of unknown etiology that involves predominantly synovial articulations, which can lead to deformity and destruction. With the progression of the disease, patients with Rheumatoid Arthritis develop inability to perform activities of daily living both as a professional, generating a significant economic impact for the patient and to society. Although the exact cause of rheumatoid arthritis remains unknown, studies conducted over the past two decades has enabled greater understanding of the pathogenesis of this disease. This knowledge has allowed the development of new therapies used to treat severe forms of the disease. The main goal of treatment is to achieve remission, however, when this can not be expected to prevent joint damage and loss of function and even reduce pain. The latest strategies for the treatment of Rheumatoid Arthritis involve the early diagnosis and aggressive control of inflammation. The recognition of pro-inflammatory cytokines expressed more as tumor necrosis factor α (TNF-α) and interleukin (IL) 1 and IL6 enabled developing new therapies directed against these cytokines targets. TNF-α is a proinflammatory cytokine that plays a key role in immune response, defense against microorganisms and the inflammatory process. Biological agents that inhibit TNF-α are considered effective in reducing activity and in the retardation of structural joint damage in rheumatoid arthritis, especially in forms refractory to conventional treatments. Currently, they are available in Brazil, three anti-TNF-α: infliximab, etanercept and adalimumab. These drugs are relatively safe for Rheumatoid Arthritis, but may, however, present serious infectious complications such as reactivation of latent tuberculosis.The high cost of these drugs, their use in hospital and the risk to opportunistic infections remain the limiting factors for its widespread use in the treatment of Rheumatoid Arthritis in our midst. This study aims at highlighting the importance of the emergence of new therapies in order to attenuate the progression of rheumatoid arthritis, and to analyze risk-benefit offered by their treatment and assess the feasibility and cost of the same. <p><p> A Artrite Reumatóide é uma doença crônica, sistêmica, autoimune, de etiologia desconhecida, que envolve predominantemente as articulações sinoviais, o que pode acarretar deformidade e destruição das mesmas. Com a progressão da doença, os pacientes com Artrite Reumatóide desenvolvem incapacidade para realização de suas atividades tanto de vida diária como profissional, gerando um impacto econômico significativo para o paciente e para a sociedade. Embora a causa exata da Artrite Reumatóide permaneça desconhecida, estudos realizados ao longo das duas últimas décadas possibilitaram maior compreensão da patogenia desta doença. Este conhecimento vem permitindo o desenvolvimento de novas terapias usadas para tratar as formas mais graves da doença. O principal objetivo do tratamento é atingir a remissão, no entanto, quando este não for possível, espera-se a prevenção do dano articular e da perda da função e ainda redução da dor. As mais recentes estratégias para o tratamento da Artrite Reumatóide envolvem o diagnóstico precoce e o controle agressivo do processo inflamatório. O reconhecimento de citocinas pró-inflamatórias mais expressas como o fator de necrose tumoral α (TNF-α) e interleucina (IL) 1 e IL6 possibilitou o surgimento de novas terapias dirigidas contra essas citocinas alvos. O TNF-α é uma citocina pró-inflamatória que desempenha papel chave na resposta imune, na defesa contra microrganismos e no processo inflamatório. Agentes biológicos que inibem o TNF-α são considerados eficazes na redução da atividade e no retardamento do dano estrutural articular na Artrite Reumatóide, em especial nas formas refratárias aos tratamentos convencionais. Atualmente, estão disponíveis no mercado brasileiro, três agentes anti-TNF-α: infliximabe, etanercepte e adalimumabe. Estes agentes são relativamente seguros para Artrite Reumatóide, mas podem, no entanto, apresentar complicações infecciosas graves, como a reativação da tuberculose latente. O alto custo dessas drogas, seu uso em nível hospitalar e o risco a infecções oportunistas permanecem como fatores limitantes para sua ampla utilização no tratamento da Artrite Reumatóide em nosso meio. Este estudo tem como objetivo destacar a importância do surgimento de novas terapias com intuito de atenuar a progressão da Artrite Reumatóide, bem como analisar risco-benefício oferecidos pelo respectivo tratamento e ainda avaliar viabilidade e custo do mesmo

Revisão sistematizada da literatura e opinião de peritos

Objective: The 3E (Evidence, Expertise, Exchange) Initiative is a multinational effort of rheumatologists aimed at developing evidence-based recommendations addressing specific questions relevant to clinical practice. The objective of the Portuguese contribution for the 3E Initiative was to develop evidence-based recommendations on how to investigate, follow-up and treat undifferentiated peripheral inflammatory arthritis (UPIA) adapted to local reality and develop additional recommendations considered relevant in the national context. Methods: An international scientific committee from 17 countries selected a set of questions concerning the diagnosis and monitoring of UPIA using a Delphi procedure. Evidence-based answers to each question were sought by a systematic literature search, performed in Medline, Embase, the Cochrane Library and ACR/EULAR 2007-2009 meeting abstracts. Relevant articles were reviewed for quality assessment, data extraction and synthesis. In a national meeting, a panel of 63 Portuguese rheumatologists used the evidence which was gathered to develop recommendations, and filled the gaps in the evidence with their expert opinion. Finally, national recommendations were formulated and agreement among the participants was assessed. Results: A total of 54754 references were identified, of which 267 were systematically reviewed. Thirteen national key recommendations about the investigation, follow-up and treatment of UPIA were formulated. One recommendation addressed differential diagnosis and investigations prior to the established operational diagnosis of UPIA, eight recommendations were related to the diagnostic and prognostic value of clinical and laboratory assessments in established UPIA (history and physical examination, acute phase reactants, serologies, autoantibodies, radiographs, magnetic resonance imaging and ultrasound, genetic markers and synovial biopsy), one recommendation highlighted predictors of persistence (chronicity), one addressed monitoring of clinical disease activity in UPIA, one aimed to find an useful method/score to predict a definitive diagnosis and the last one was related to treatment. Conclusion: Portuguese evidence-based recommendations for the management of UPIA in everyday practice were developed. Their dissemination and implementation in daily clinical practice should help to improve practice uniformity and optimize the management of UPIA patients.publishersversionpublishe

Portuguese recommendations for the use of methotrexate in the treatment of rheumatoid arthritis

Objectives:To develop Portuguese evidence-based recommendations for the use of methotrexate (MTX) in daily clinical practice in rheumatic disorders. Methods:The Portuguese project was integrated in the multinational 3E Initiative (Evidence, Expertise, Exchange) 2007-2008 where a total of 751 rheumatologists from 17 countries have participated. Ten clinical questions concerning the use of MTX in rheumatic diseases were formulated and the Portuguese group added three more questions. A systematic literature search in Medline, Embase, Cochrane Library and 2005-2007 ACR/EULAR meeting abstracts was conducted. Selected articles were systematically reviewed and the evidence was appraised according to the Oxford Levels of Evidence. In Portugal, a national meeting was held in Obidos on February 15 th and 16 th, 2008, involving 50 rheumatologists who discussed and voted by Dephi method the recommendations. Finally, the agreement among the rheumatologists and the potential impact on their clinical practice was assessed. Results: Thirteen national key recommendations on the use of MTX were formulated: work-up before starting MTX, optimal dosage and route of administration, use of folic acid, monitoring, management of hepatotoxicity, long-term safety, mono versus combination therapy, management in the perioperative period, during infections, before/during pregnancy and after clinical remission, screening and treatment of tuberculosis and the role of MTX as a steroid-sparing agent in rheumatic diseases. Discussion: The Portuguese recommendations for the use of MTX in daily clinical practice were developed, which are evidence-based and supported by a panel of 50 rheumatologists, enhancing their validity and practical use. This project was integrated in a multinational initiative that led to the recent publication of ten multinational recommendations which differ from ours in some specific aspects.publishersversionpublishe