Outcome measures in ankylosing spondylitis

Ankylosing spondylitis is a chronic and progressive disease involving predominantly the axial skeleton. It is insidious and potentially debilitating, compromising the quality of life of patients suffering from the disease. The etiopathogenesis is still uncertain, which difficult strategies in its diagnosis and treatment. Advances in biological therapies are reforcing discussions in the best way of managing the disease. In this paper, we revise the outcome instruments available for ankylosing spondylitis and the consensus from the ASAS working group (Assessments in Ankylosing Spondylitis Working Group) established at the OMERACT IV (Outcome Measures in Rheumatology).A espondilite anquilosante (EA) é uma doença inflamatória crônica caracterizada por acometimento predominante do esqueleto axial. Ocorre de forma insidiosa e é potencialmente debilitante, levando à redução na qualidade de vida dos indivíduos acometidos. A sua etiopatogenia ainda não está totalmente esclarecida, dificultando estratégias no seu diagnóstico e manejo. O avanço da terapia com agentes biológicos veio reforçar discussões sobre a melhor forma de avaliação destes pacientes. Nesta revisão, discutimos os principais instrumentos utilizados para avaliar pacientes com EA e o consenso do grupo internacional (ASAS working group - Assessments in Ankylosing Spondylitis Working Group) determinado no OMERACT IV (Outcome Measures in Rheumatology).UNIFESPUNIFESP, EPM, São Paulo, BrazilSciEL

Variables related to work productivity loss in patients with ankylosing spondylitis

The work productivity loss due to ankylosing spondylitis (AS) has become subject of interest because of its socioeconomic impact. In addition to physical limitations, other variables seem to affect the productivity of those patients, who often withdraw early from the labor force. This review was aimed at identifying articles published in English, from January 2001 to December 2011, which assessed those variables in adult patients of both sexes diagnosed with AS, using standardized instruments to measure disease activity and work productivity. Thirty-three articles meeting the inclusion criteria were identified. The work productivity loss of patients with AS proved to be influenced by demographics, emotional, social, cultural, and occupational factors, and lifestyle. Understanding those potential risk factors may contribute to the development of preventive strategies to maintain patients with AS participating in the labor force.A perda da produtividade no trabalho, como resultado da espondilite anquilosante, tem se tornado tema de interesse dado o seu impacto socioeconômico. Além das limitações físicas, outras variáveis parecem interferir na produtividade desses pacientes que muitas vezes são aposentados precocemente do mercado de trabalho. Assim, esse manuscrito de revisão buscou identificar artigos publicados na língua inglesa no período de janeiro de 2001 a dezembro de 2011 que discutissem essas variáveis por meio de estudos realizados com pacientes adultos com diagnóstico de espondilite anquilosante, de ambos os gêneros e que usaram instrumentos padronizados para a avaliação da atividade da doença e da capacidade produtiva no trabalho. Foram identificados 33 artigos atendendo aos critérios de inclusão e observou-se que a perda de produtividade no trabalho em pacientes com espondilite anquilosante é influenciada por variáveis demográficas, emocionais, socioculturais e ocupacionais e hábitos de vida. Compreender esses possíveis fatores de risco pode colaborar para a elaboração de estratégias preventivas para a manutenção de pacientes com espondilite anquilosante no mercado de trabalho.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

O SF-36 e o desenvolvimento de novas medidas de avaliação de qualidade de vida

The use of assessment tools for quality of life has allowed the incorporation of the views of patients in health decision-making. This article presents the characteristics and changes experienced by one of the most used questionnaires of quality of life, at present: the Short Form 36-item Health Survey (SF-36). We also discuss the issues related to the construction, properties and applications of this measuring tool and other derived measures as: the SF-12, the SF-8, the Dynamic Health Assessment (DYNHA) and the SF-6D. We emphasize the use of the SF-36 for assessing the effectiveness of interventions in health, the SF-12 for the tracking of health disorders, the SF-8 for the monitoring of population health; the DYNHA for individualized evaluations in clinical practice and the SF-6D for economic analysis in health. Information on the versions validated for Portuguese language and the permission to use the questionnaires are provided.Univ Fed Sao Paulo, Dept Med, Disciplina Reumatol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Med, Disciplina Reumatol, Sao Paulo, SP, BrazilWeb of Scienc

Causes of unplanned interruption of radiotherapy

OBJECTIVE: To evaluate the occurrence and causes of unplanned interruption of radiotherapy. MATERIALS AND METHODS: Retrospective study developed in the Division of Radiotherapy of Hospital Alemão Oswaldo Cruz in São Paulo, SP, Brazil, with data collected from 560 dossiers of patients submitted to radiotherapy in the period between January 1, 2005 and December 31, 2005. Chi-squared and Student t tests were utilized in the data analysis, and p < 0.05 was considered as statistically significant. RESULTS: Interruption of treatment was identified in 350 cases, corresponding to 62.5% of the patients. The reasons for treatment interruption were the following: preventive device maintenance (55%), patient's own private reasons (13%), adverse reactions to the treatment or to combined radiotherapy/chemotherapy (6%), clinical worsening (3%), two or more combined reasons (23%). The interruption time interval ranged between 1 and 24 days (mean 1.4 day). One-day interruption was mostly due to preventive device maintenance (84.4%); two-five-day interruption was due to combined reasons (48.28%). CONCLUSION: The most frequent cause of interruption was preventive device maintenance, with maximum two-day time interval.OBJETIVO: Avaliar a ocorrência e as causas de interrupção não-programadas da radioterapia. MATERIAIS E MÉTODOS: Estudo retrospectivo realizado no Serviço de Radioterapia do Hospital Alemão Oswaldo Cruz, na cidade de São Paulo, SP. Os dados foram obtidos dos prontuários dos 560 pacientes submetidos a radioterapia, de 1º de janeiro de 2005 a 31 de dezembro de 2005. Os dados foram analisados pelos testes qui-quadrado e t Student, e os valores de p < 0,05 foram considerados com significância estatística. RESULTADOS: Foram identificados 350 pacientes que interromperam seus tratamentos, o que representou 62,5% do total da amostra. Os motivos foram: manutenção do aparelho (55%), motivos particulares dos pacientes (13%), reações do tratamento ou da associação com quimioterapia (6%), piora clínica (3%), associação de motivos (23%). O intervalo de tempo de interrupção variou de 1 a 24 dias, com média geral de 1,4 dia. Na interrupção de um dia a maior incidência foi ocasionada pela manutenção (84,4%); de dois a cinco dias a interrupção foi causada pela associação de motivos (48,28%). CONCLUSÃO: A causa mais freqüente de interrupção encontrada foi a manutenção preventiva e seu intervalo máximo foi de dois dias.Hospital Alemão Oswaldo CruzUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de MedicinaUNIFESP, EPM, Depto. de MedicinaSciEL

Instrumentos de avaliação em reumatologia: importância de sua tradução e validação para nosso idioma

Revista Brasileira de ReumatologiaUniversidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Quality of life and health status evaluation measurements

Measurements of quality of life and health status have been emphasized by the orthopedic community because they allow for an analysis of the health status and disease manifestations according to the own point of view of the individual. Studies have carefully analyzed the tools available and published recommendations for the most adequate choice of such tools. This study provides a brief description of the types of instruments, their application, their validation procedure, the instruments that are more commonly seen in the international literature, and those available for use in Brazil.Medidas de qualidade de vida e estado de saúde têm sido enfatizados pela comunidade ortopédica por possibilitarem a análise da situação de saúde e as manifestações da doença na vida do indivíduo em sua própria perspectiva. Estudos têm analisado criteriosamente os instrumentos disponíveis e publicado recomendações direcionando a escolha dos mais adequados para o uso. O presente estudo fornece descrição breve dos tipos de instrumentos, suas aplicabilidades, o processo de validação, os instrumentos mais comumente utilizados na literatura internacional e aqueles disponíveis para uso no Brasil.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Ortopedia e TraumatologiaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de MedicinaUNIFESP, EPM, Depto. de Ortopedia e TraumatologiaUNIFESP, EPM, Depto. de MedicinaSciEL

Topical anti-inflammatory drugs in osteoarthritis of the knee

Oral non-steroidal anti-inflammatories drugs (NSAIDs) are effective in pain relief in osteoarthritis (OA), but are also associated with risks of adverse systemic side effects. In order to reduce its toxicity, it would be desirable to decrease the plasmatic levels of NSAIDs since those side effects are dose-dependent. Topical NSAIDs would be a therapeutic alternative in theory, because while they reach high levels in local tissues, they also produce low plasmatic levels. Our review analyzed clinical randomized and shown that topical NSAIDs were superior to placebo and have similar efficacy to oral NSAIDs, but due a few number of trials and methodological weaknesses we can't make definitive conclusions. Further well designed, long term studies are required.Os antiinflamatórios não-esteroidais (AINEs) orais são eficazes no alívio da dor na osteoartrite (OA), porém têm o risco de efeitos adversos sistêmicos. Para diminuir a toxicidade é necessário reduzir a concentração plasmática uma vez que os efeitos adversos são dose-dependentes. Os AINEs de uso tópico, em teoria, alcançam altas concentrações nos tecidos-alvo com concentrações plasmáticas baixas, sendo portanto uma alternativa terapêutica, especialmente para pacientes de risco. Nossa revisão dos ensaios clínicos randomizados mostrou que os AINEs tópicos foram mais efetivos que o placebo e tão eficazes quanto os AINEs orais. Porém, o pequeno número de ensaios e falhas na metodologia nos impossibilita de fazer conclusões definitivas, sendo necessários estudos bem desenhados e de maior duração.Universidade Federal do Amazonas Hospital Universitário Getúlio VargasUniversidade Federal de São Paulo (UNIFESP)UFAM Departamento da Clínica Médica da Disciplina de ReumatologiaUNIFESPUNIFESP Departamento de MedicinaUNIFESP, Depto. de MedicinaSciEL

Cultural adaptation and validation of the Kidney Disease and Quality of Life - Short Form (KDQOL-SF 1.3) in Brazil

The objective of the present study was to translate the Kidney Disease Quality of Life - Short Form (KDQOL-SF 1.3) questionnaire into Portuguese to adapt it culturally and validate it for the Brazilian population. The KDQOL-SF was translated into Portuguese and back-translated twice into English. Patient difficulties in understanding the questionnaire were evaluated by a panel of experts and solved. Measurement properties such as reliability and validity were determined by applying the questionnaire to 94 end-stage renal disease patients on chronic dialysis. The Nottingham Health Profile Questionnaire, the Karnofsky Performance Scale and the Kidney Disease Questionnaire were administered to test validity. Some activities included in the original instrument were considered to be incompatible with the activities usually performed by the Brazilian population and were replaced. The mean scores for the 19 components of the KDQOL-SF questionnaire in Portuguese ranged from 22 to 91. The components Social support and Dialysis staff encouragement had the highest scores (86.7 and 90.8, respectively). The test-retest reliability and the inter-observer reliability of the instrument were evaluated by the intraclass correlation coefficient. The coefficients for both reliability tests were statistically significant for all scales of the KDQOL-SF (P < 0.001), ranging from 0.492 to 0.936 for test-retest reliability and from 0.337 to 0.994 for inter-observer reliability. The Cronbach's alpha coefficient was higher than 0.80 for most of components. The Portuguese version of the KDQOL-SF questionnaire proved to be valid and reliable for the evaluation of quality of life of Brazilian patients with end-stage renal disease on chronic dialysis.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de MedicinaUNIFESP, EPM, Depto. de MedicinaSciEL