89 research outputs found

    Ambulatório conjunto de Dermatologia e Reumatologia para tratamento de psoríase e artrite psoriásica: experiência de um hospital terciário no sul do Brasil

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    Introduction: several guidelines emphasize the advantages of multidisciplinary management of patients with psoriasis (PSO) or psoriatic arthritis (PSA). Early diagnosis of PSA relates to better outcomes in 5 years. However, early diagnosis of PSA remains a challenge. Methods: retrospective cohort of patients with previous or suspect diagnosis of PSO and/or PSA who were cared for in the combined dermatology and rheumatology clinic from January 2013 to January 2017.Results: among the 55 patients previously diagnosed with PSO, 30.9% (n=17) were diagnosed with PSA. Changes in medical therapy were made for 58.5% (n = 48) of patients, mainly due to poor cutaneous or articular disease control. Imunobiologicals were the most commonly initiated class of medicine, corresponding to 35.4% (n = 17) of changes in medical therapy. Methotrexate was the second most initiated medicine (18.7%; n = 9), or with changes in its dosage or route of administration (20.8%; n = 10), totaling 39.5% (n = 19) of changes in medical therapy. There was an increase in the proportions of patients undergoing systemic therapies (79.2%; n = 65).Conclusions: this study reenforces the importance of a multidisciplinary approach in the early diagnosis of PSA and demonstrates that a combined approach between dermatology and rheumatology is feasible in Brazil, with similar outcomes to those reported in international literature

    Ambulatório conjunto de Dermatologia e Reumatologia para tratamento de psoríase e artrite psoriásica: experiência de um hospital terciário no sul do Brasil

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    Introduction: several guidelines emphasize the advantages of multidisciplinary management of patients with psoriasis (PSO) or psoriatic arthritis (PSA). Early diagnosis of PSA relates to better outcomes in 5 years. However, early diagnosis of PSA remains a challenge. Methods: retrospective cohort of patients with previous or suspect diagnosis of PSO and/or PSA who were cared for in the combined dermatology and rheumatology clinic from January 2013 to January 2017.Results: among the 55 patients previously diagnosed with PSO, 30.9% (n=17) were diagnosed with PSA. Changes in medical therapy were made for 58.5% (n = 48) of patients, mainly due to poor cutaneous or articular disease control. Imunobiologicals were the most commonly initiated class of medicine, corresponding to 35.4% (n = 17) of changes in medical therapy. Methotrexate was the second most initiated medicine (18.7%; n = 9), or with changes in its dosage or route of administration (20.8%; n = 10), totaling 39.5% (n = 19) of changes in medical therapy. There was an increase in the proportions of patients undergoing systemic therapies (79.2%; n = 65).Conclusions: this study reenforces the importance of a multidisciplinary approach in the early diagnosis of PSA and demonstrates that a combined approach between dermatology and rheumatology is feasible in Brazil, with similar outcomes to those reported in international literature

    Combined dermatology and rheumatology outpatient clinic for the management of psoriasis and psoriatic arthritis : a southern Brazilian experience

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    Introdu√ß√£o: Diversas diretrizes enfatizam as vantagens do manejo multidisciplinar no cuidado ao paciente com psor√≠ase (PSO) e artrite psori√°sica (PSA). O diagn√≥stico precoce de PSA se relaciona com melhores desfechos em 5 anos. No entanto, o diagn√≥stico precoce de PSA ainda √© um desafio. M√©todos: Estudo transversal retrospectivo de pacientes com diagn√≥stico pr√©vio ou suspeito de PSO e/ou PSA atendidos em ambulat√≥rio conjunto de dermatologia e reumatologia do sul do Brasil de janeiro de 2013 a janeiro de 2017. Resultados: Entre os 55 pacientes previamente diagnosticados com PSO, 30,9% (n = 17) foram diagnosticados com PSA. Altera√ß√Ķes do tratamento foram feitas em 58,5% (n = 48) dos pacientes, principalmente devido ao mau controle da pele e das articula√ß√Ķes. Os imunobiol√≥gicos foram a classe de medicamentos mais comumente iniciada, correspondendo a 35,4% (n = 17) das modifica√ß√Ķes terap√™uticas. O metotrexato foi o segundo medicamento mais comumente iniciado (18,8%, n = 9) ou com modifica√ß√£o da dose ou via de administra√ß√£o (20,8%, n = 10), totalizando 39,6% (n = 19) de modifica√ß√Ķes terap√™uticas. Houve um aumento na propor√ß√£o de pacientes em uso de tratamento sist√™mico (79,3%, n = 65). Conclus√£o: Este estudo refor√ßa a import√Ęncia da abordagem multidisciplinar no diagn√≥stico precoce da PSA e demonstra que a abordagem conjunta entre dermatologia e reumatologia √© poss√≠vel de ser realizada no Brasil, com resultados semelhantes aos reportados na literatura internacional.Introduction: Several guidelines emphasize the advantages of multidisciplinary management of patients with psoriasis (PSO) or psoriatic arthritis (PSA). Early diagnosis of PSA is associated with better outcomes in 5 years. However, early diagnosis of PSA remains a challenge. Methods: We conducted a retrospective cross-sectional study of patients with previous or suspected diagnosis of PSO and/or PSA treated at a combined dermatology and rheumatology outpatient clinic in southern Brazil from January 2013 to January 2017. Results: Of 55 patients previously diagnosed with PSO, 30.9% (n = 17) were diagnosed with PSA. Changes in treatment were made in 58.5% (n = 48) of patients, mainly due to poor control of cutaneous and articular symptoms. Immunobiological agents were the most commonly prescribed class of drugs, corresponding to 35.4% (n = 17) of changes in medical therapy. Methotrexate was the second most commonly prescribed drug (18.8%; n = 9) and the second drug to undergo most changes in dose or route of administration (20.8%; n = 10), accounting for 39.6% (n = 19) of changes in medical therapy. There was an increase in the number of patients undergoing systemic therapies (79.3%; n = 65). Conclusions: This study reinforces the importance of a multidisciplinary approach in the early diagnosis of PSA and demonstrates that a collaborative approach between dermatology and rheumatology is feasible in Brazil, with outcomes similar to those reported in the international literature

    Qualidade de vida em pacientes adultos e pediátricos com vitiligo : estudo baseado em questionários de qualidade de vida genéricos e específicos

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    Introdu√ß√£o: O vitiligo √© uma doen√ßa da pele frequente que afeta cerca de 1% da popula√ß√£o em todo o mundo. Ocorre em pessoas de qualquer idade ou etnia, e mais da metade dos pacientes desenvolvem a doen√ßa antes dos 20 anos de idade. O vitiligo pode afetar negativamente a qualidade de vida (QoL) do paciente. Um question√°rio de qualidade de vida espec√≠fico para vitiligo foi desenvolvido e validado na l√≠ngua inglesa: the vitiligo-specific quality-of-life instrument (VitiQoL). Objetivo: O objetivo deste estudo √© avaliar a QoL em pacientes adultos com o VitiQoL e o DLQI e pedi√°tricos com o CDLQI em uma amostra de pacientes com vitiligo no sul do Brasil. M√©todos: Na primeira etapa, o instrumento foi traduzido, adaptado culturalmente e validado para o portugu√™s falado no Brasil (VitiQoL-PB). Ap√≥s, foram inclu√≠dos pacientes selecionados no Ambulat√≥rio de Dermatologia do Hospital de Cl√≠nicas de Porto Alegre e numa cl√≠nica privada de Porto Alegre. Foi realizada amostragem de conveni√™ncia de casos consecutivos. A qualidade de vida de pacientes pedi√°tricos foi avaliada com o question√°rio CDLQI. Em pacientes adultos foram aplicados o VitiQoL ‚Äď PB e o DLQI. Resultados: Observou-se uma forte correla√ß√£o entre os escores do total de VitiQoL e o DLQI (r = 0,81; p <0,001). O fator que mais contribuiu para a pontua√ß√£o final do VitiQoL foi estigma. Em nossa amostra, as mulheres apresentaram escores mais elevados do que os homens (p <0,05). Problemas psiqui√°tricos foram associados com uma pior qualidade de vida. Na popula√ß√£o pedi√°trica, a mediana do escore do CDLQI foi 3 (intervalo interquartil 1,3-7,3). Houve uma correla√ß√£o estatisticamente significativa entre a idade da crian√ßa e o escore no CDLQI (rs = 0,41, p = 0,044). N√£o houve diferen√ßa entre meninos e meninas (p = 0,219). Conclus√£o: Este estudo confirma n√£o s√≥ que o VitiQoL √© f√°cil de administrar, como tamb√©m, acrescenta informa√ß√Ķes importantes sobre o impacto do vitiligo na Am√©rica do Sul. Instrumentos gen√©ricos s√£o √ļteis e permitem compara√ß√Ķes com outras dermatoses, mas n√£o s√£o suficientemente espec√≠ficos para detectar nuances na maneira como os pacientes lidam com o vitiligo. A autoestima dos pacientes √© muito afetada e a estigmatiza√ß√£o est√° bastante presente. H√° grupos de pacientes que s√£o mais vulner√°veis ao impacto da doen√ßa, como as mulheres, os adolescentes e os pacientes com doen√ßas psiqui√°tricas.Background: Vitiligo is a common skin disease that has been reported to affect approximately 1 % of the population worldwide. It affects people of any age or ethnicity, more than half of who develop it before the age of 20 years. Vitiligo can negatively affect patient‚Äôs quality of life (QoL). A specific questionnaire for vitiligo has been developed and validated in the English language: the vitiligo-specific quality-of-life instrument (VitiQoL). Objective: The aim of this study was to access the QoL in adult patients through VitiQoL and DLQI and pediatric patients through CDLQI in a sample of patients with vitiligo in Southern Brazil. Methods: In the first phase of the study the instrument was translated, cultural adapted and validated into Brazilian Portuguese (VitiQoL-PB). Then patients were selected from a Dermatological Outpatient Clinic from Hospital de Cl√≠nicas de Porto Alegre and from a Private Practice in Porto Alegre. In this study, we used convenience sampling of consecutive cases. The QoL of pediatric patients was performed using the CDLQI questionnaire. In adult patients we applied the VitiQoL ‚Äď PB and the DLQI. Results: A strong correlation between the scores of the total VitiQoL and DLQI was observed (r = 0.81; p <0.001). The factor that most contributed to the final score of VitiQoL was stigma. In our sample, women had higher scores than men (p<0,05). Psychiatric problems were associated with lower QoL. In the pediatric population, the median score of CDLQI was 3 (interquartile range 1.3 to 7.3). There was a statistically significant correlation between the child's age and the score on CDLQI (rs = 0.41, p = 0.044). There was no difference between boys and girls (p = 0.219). Conclusion: This study confirms that VitiQoL is easy to administer and adds important information about the impact of vitiligo on a South American population. Generic instruments are useful and allow comparisons with other dermatoses, but are not specific enough to detect nuances in how patients deal with the overall vitiligo burden. Self-esteem of patients is greatly affected and stigmatization is very present in the disease. There are groups of patients that are more vulnerable to the impact of the disease, like women, patients with psychiatric diseases and adolescents

    Qualidade de vida em pacientes adultos e pediátricos com vitiligo : estudo baseado em questionários de qualidade de vida genéricos e específicos

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    Introdu√ß√£o: O vitiligo √© uma doen√ßa da pele frequente que afeta cerca de 1% da popula√ß√£o em todo o mundo. Ocorre em pessoas de qualquer idade ou etnia, e mais da metade dos pacientes desenvolvem a doen√ßa antes dos 20 anos de idade. O vitiligo pode afetar negativamente a qualidade de vida (QoL) do paciente. Um question√°rio de qualidade de vida espec√≠fico para vitiligo foi desenvolvido e validado na l√≠ngua inglesa: the vitiligo-specific quality-of-life instrument (VitiQoL). Objetivo: O objetivo deste estudo √© avaliar a QoL em pacientes adultos com o VitiQoL e o DLQI e pedi√°tricos com o CDLQI em uma amostra de pacientes com vitiligo no sul do Brasil. M√©todos: Na primeira etapa, o instrumento foi traduzido, adaptado culturalmente e validado para o portugu√™s falado no Brasil (VitiQoL-PB). Ap√≥s, foram inclu√≠dos pacientes selecionados no Ambulat√≥rio de Dermatologia do Hospital de Cl√≠nicas de Porto Alegre e numa cl√≠nica privada de Porto Alegre. Foi realizada amostragem de conveni√™ncia de casos consecutivos. A qualidade de vida de pacientes pedi√°tricos foi avaliada com o question√°rio CDLQI. Em pacientes adultos foram aplicados o VitiQoL ‚Äď PB e o DLQI. Resultados: Observou-se uma forte correla√ß√£o entre os escores do total de VitiQoL e o DLQI (r = 0,81; p <0,001). O fator que mais contribuiu para a pontua√ß√£o final do VitiQoL foi estigma. Em nossa amostra, as mulheres apresentaram escores mais elevados do que os homens (p <0,05). Problemas psiqui√°tricos foram associados com uma pior qualidade de vida. Na popula√ß√£o pedi√°trica, a mediana do escore do CDLQI foi 3 (intervalo interquartil 1,3-7,3). Houve uma correla√ß√£o estatisticamente significativa entre a idade da crian√ßa e o escore no CDLQI (rs = 0,41, p = 0,044). N√£o houve diferen√ßa entre meninos e meninas (p = 0,219). Conclus√£o: Este estudo confirma n√£o s√≥ que o VitiQoL √© f√°cil de administrar, como tamb√©m, acrescenta informa√ß√Ķes importantes sobre o impacto do vitiligo na Am√©rica do Sul. Instrumentos gen√©ricos s√£o √ļteis e permitem compara√ß√Ķes com outras dermatoses, mas n√£o s√£o suficientemente espec√≠ficos para detectar nuances na maneira como os pacientes lidam com o vitiligo. A autoestima dos pacientes √© muito afetada e a estigmatiza√ß√£o est√° bastante presente. H√° grupos de pacientes que s√£o mais vulner√°veis ao impacto da doen√ßa, como as mulheres, os adolescentes e os pacientes com doen√ßas psiqui√°tricas.Background: Vitiligo is a common skin disease that has been reported to affect approximately 1 % of the population worldwide. It affects people of any age or ethnicity, more than half of who develop it before the age of 20 years. Vitiligo can negatively affect patient‚Äôs quality of life (QoL). A specific questionnaire for vitiligo has been developed and validated in the English language: the vitiligo-specific quality-of-life instrument (VitiQoL). Objective: The aim of this study was to access the QoL in adult patients through VitiQoL and DLQI and pediatric patients through CDLQI in a sample of patients with vitiligo in Southern Brazil. Methods: In the first phase of the study the instrument was translated, cultural adapted and validated into Brazilian Portuguese (VitiQoL-PB). Then patients were selected from a Dermatological Outpatient Clinic from Hospital de Cl√≠nicas de Porto Alegre and from a Private Practice in Porto Alegre. In this study, we used convenience sampling of consecutive cases. The QoL of pediatric patients was performed using the CDLQI questionnaire. In adult patients we applied the VitiQoL ‚Äď PB and the DLQI. Results: A strong correlation between the scores of the total VitiQoL and DLQI was observed (r = 0.81; p <0.001). The factor that most contributed to the final score of VitiQoL was stigma. In our sample, women had higher scores than men (p<0,05). Psychiatric problems were associated with lower QoL. In the pediatric population, the median score of CDLQI was 3 (interquartile range 1.3 to 7.3). There was a statistically significant correlation between the child's age and the score on CDLQI (rs = 0.41, p = 0.044). There was no difference between boys and girls (p = 0.219). Conclusion: This study confirms that VitiQoL is easy to administer and adds important information about the impact of vitiligo on a South American population. Generic instruments are useful and allow comparisons with other dermatoses, but are not specific enough to detect nuances in how patients deal with the overall vitiligo burden. Self-esteem of patients is greatly affected and stigmatization is very present in the disease. There are groups of patients that are more vulnerable to the impact of the disease, like women, patients with psychiatric diseases and adolescents
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