Avaliação do manejo da gota, com foco especial no contexto da doença renal crônica
Autor(a) principal: | |
---|---|
Data de Publicação: | 2018 |
Tipo de documento: | Tese |
Idioma: | por |
Título da fonte: | Biblioteca Digital de Teses e Dissertações da UERJ |
Texto Completo: | http://www.bdtd.uerj.br/handle/1/8539 |
Resumo: | Gout is one of the most prevalent inflammatory arthritis among adults less common than osteoarthritis and calcium pyrophosphate deposition disease only. It is characterized by recurrent flares of very painful acute arthritis and may present macroscopic deposits of uric acid (tophi). Although it was first described over 4,000 years ago, has defined etiology, relatively easy diagnosis and available treatment, gout is still inadequately treated and it is associated with high morbimortality and negative effect on quality of life. This thesis aimed to investigate the management of gout, stressing the context of chronic kidney disease. Specific objectives were: (i) to describe and analyze current practices of gout management among Brazilian rheumatologists (study 1); (ii) to review the management of gout and hyperuricemia in the context of chronic kidney disease (study 2), (iii) to review the relation between hyperuricemia and urate-lowering therapy and renal outcomes (study 2), and (iv) to evaluate the effect of allopurinol on kidney function of individuals with gout (study 3). Study 1 was a survey on the treatment of gout in a random sample of 309 Brazilian rheumatologists. Study 2 was a narrative review on the management of gout in the context of chronic kidney disease and the effects of hyperuricemia and urate-lowering therapy on kidney function. In study 3, we investigated a cohort of 9520 adults residents in the United Kingdom with recently-diagnosed gout, stratified by time, matched by propensity score. We evaluated the effects of the incident use of ≥300 mg/day of allopurinol on the kidney function of patients without chronic kidney disease. Study 1 revealed that the Brazilian rheumatologists had unsatisfactory knowledge, especially the non-recognition of gouty tophi as an indication for urate-lowering therapy, the withdrawal of the urate-lowering therapy during a gout flare, the initial prescription of allopurinol in high doses and the non-recognition that urate-lowering therapy should be maintained indefinitely. In study 2, we synthesized the most updated recommendations on the management of urate-lowering therapy, anti-inflammatory prophylaxis and the treatment of gout flares. We also showed the deleterious effects of hyperuricemia and the potential benefits of urate-lowering therapy on kidney function. The results of the papers included in this review varied from a protective effect of the urate-lowering therapy to the non-identification of a significant association, with no article pointing out deleterious effect of the urate-lowering therapy on the kidneys. We identified large heterogeneity in the inclusion criteria of the participants, with few papers evaluating gout patients exclusively, and some methodological issues that could lead to biased findings. In Study 3 we identified a renoprotective effect of allopurinol, with a 13% reduction in the risk of developing chronic kidney disease stage ≥3. Considering the lack of knowledge about gout management, especially in patients with compromised kidney function, and in light of the body of evidence of the broad benefits of urate-lowering therapy, it is of great importance that continuing education programs about gout management are proposed to guarantee that patients receive a more adequate and complete treatment. |
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Pinheiro, Geraldo da Rocha Castelarhttp://lattes.cnpq.br/7536115815141738Klumb, Evandro Mendeshttp://lattes.cnpq.br/3194331454644472Suassuna, José Hermógenes Roccohttp://lattes.cnpq.br/0065381779108423Azevedo, Valderilio Feijóhttp://lattes.cnpq.br/0102178796973154Cunha, Geraldo Marcelo dahttp://lattes.cnpq.br/4238249453763776http://lattes.cnpq.br/4974621854484453Santos, Ana Beatriz Vargas dos2021-01-05T19:35:45Z2019-11-132018-09-17SANTOS, Ana Beatriz Vargas dos. Avaliação do manejo da gota, com foco especial no contexto da doença renal crônica. 2018. 174 f. Tese (Doutorado em Ciências Médicas) - Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2018.http://www.bdtd.uerj.br/handle/1/8539Gout is one of the most prevalent inflammatory arthritis among adults less common than osteoarthritis and calcium pyrophosphate deposition disease only. It is characterized by recurrent flares of very painful acute arthritis and may present macroscopic deposits of uric acid (tophi). Although it was first described over 4,000 years ago, has defined etiology, relatively easy diagnosis and available treatment, gout is still inadequately treated and it is associated with high morbimortality and negative effect on quality of life. This thesis aimed to investigate the management of gout, stressing the context of chronic kidney disease. Specific objectives were: (i) to describe and analyze current practices of gout management among Brazilian rheumatologists (study 1); (ii) to review the management of gout and hyperuricemia in the context of chronic kidney disease (study 2), (iii) to review the relation between hyperuricemia and urate-lowering therapy and renal outcomes (study 2), and (iv) to evaluate the effect of allopurinol on kidney function of individuals with gout (study 3). Study 1 was a survey on the treatment of gout in a random sample of 309 Brazilian rheumatologists. Study 2 was a narrative review on the management of gout in the context of chronic kidney disease and the effects of hyperuricemia and urate-lowering therapy on kidney function. In study 3, we investigated a cohort of 9520 adults residents in the United Kingdom with recently-diagnosed gout, stratified by time, matched by propensity score. We evaluated the effects of the incident use of ≥300 mg/day of allopurinol on the kidney function of patients without chronic kidney disease. Study 1 revealed that the Brazilian rheumatologists had unsatisfactory knowledge, especially the non-recognition of gouty tophi as an indication for urate-lowering therapy, the withdrawal of the urate-lowering therapy during a gout flare, the initial prescription of allopurinol in high doses and the non-recognition that urate-lowering therapy should be maintained indefinitely. In study 2, we synthesized the most updated recommendations on the management of urate-lowering therapy, anti-inflammatory prophylaxis and the treatment of gout flares. We also showed the deleterious effects of hyperuricemia and the potential benefits of urate-lowering therapy on kidney function. The results of the papers included in this review varied from a protective effect of the urate-lowering therapy to the non-identification of a significant association, with no article pointing out deleterious effect of the urate-lowering therapy on the kidneys. We identified large heterogeneity in the inclusion criteria of the participants, with few papers evaluating gout patients exclusively, and some methodological issues that could lead to biased findings. In Study 3 we identified a renoprotective effect of allopurinol, with a 13% reduction in the risk of developing chronic kidney disease stage ≥3. Considering the lack of knowledge about gout management, especially in patients with compromised kidney function, and in light of the body of evidence of the broad benefits of urate-lowering therapy, it is of great importance that continuing education programs about gout management are proposed to guarantee that patients receive a more adequate and complete treatment.A gota é uma das artropatias inflamatórias mais prevalentes entre adultos menos frequente apenas do que a osteoartrite e a doença por depósito de cristais de pirofosfato de cálcio. Caracteriza-se por crises recorrentes de artrite aguda muito dolorosa e pode cursar com depósitos macroscópicos de ácido úrico (tofos). Apesar de ter sido descrita há mais de 4000 anos, ter etiologia definida, diagnóstico relativamente fácil e tratamento disponível, a gota continua sendo tratada de forma inadequada e está associada a alta morbimortalidade e a comprometimento da qualidade de vida. Esta tese teve como objetivo geral investigar o manejo da gota, com ênfase no contexto da doença renal crônica. Os objetivos específicos foram: (i) descrever e analisar as práticas atuais do manejo da gota entre reumatologistas brasileiros (estudo 1); (ii) revisar o manejo da gota e da hiperuricemia no contexto da doença renal crônica (estudo 2), (iii) revisar a relação da hiperuricemia e da terapia hipouricemiante com desfechos renais (estudo 2), e (iv) avaliar o efeito do alopurinol sobre a função renal de indivíduos com gota (estudo 3). O estudo 1 foi um inquérito sobre o tratamento da gota em uma amostra aleatória de 309 reumatologistas no Brasil. O estudo 2 foi uma revisão narrativa sobre o manejo da gota no contexto da doença renal crônica e sobre os efeitos da hiperuricemia e da terapia hipouricemiante sobre a função renal. No estudo 3, investigamos uma coorte de 9520 adultos residentes no Reino Unido com diagnóstico recente de gota, estratificada por tempo, pareada por escore de propensão. Avaliamos os efeitos do uso incidente de alopurinol ≥300 mg/dia sobre a função renal de pacientes sem doença renal crônica. O estudo 1 revelou conhecimento insatisfatório dos reumatologistas brasileiros, sobremodo o não reconhecimento do tofo gotoso como indicação da terapia hipouricemiante, a suspensão da terapia hipouricemiante durante uma crise aguda de gota, a prescrição inicial do alopurinol em doses altas e o não reconhecimento de que a terapia hipouricemiante deve ser mantida por tempo indeterminado. No estudo 2, sintetizamos as recomendações mais atuais sobre o manejo da terapia hipouricemiante, da profilaxia anti-inflamatória e do tratamento das crises agudas de gota. Mostramos, ainda, os efeitos deletérios da hiperuricemia e os potenciais benefícios da terapia hipouricemiante sobre a função renal. Os resultados dos trabalhos incluídos nesta revisão variaram de um efeito protetor dos hipouricemiantes à não identificação de uma associação significativa, sem nenhum artigo apontando efeito deletério da terapia hipouricemiante sobre os rins. Identificamos uma heterogeneidade grande nos critérios de inclusão dos participantes, com poucos estudos avaliando exclusivamente pacientes com gota, e alguns problemas metodológicos que poderiam gerar vieses nos achados. No estudo 3 identificamos um efeito nefroprotetor do alopurinol, com uma redução de 13% no risco de desenvolver doença renal crônica estágio ≥3. Diante do desconhecimento sobre o manejo da gota, sobretudo em pacientes com comprometimento da função renal, e das evidências sobre os benefícios amplos da terapia hipouricemiante, é de grande importância que programas de educação continuada no manejo da gota sejam propostos para garantir que os pacientes recebam um tratamento mais abrangente e adequado.Submitted by Boris Flegr (boris@uerj.br) on 2021-01-05T19:35:45Z No. of bitstreams: 1 Ana Beatriz Vargas dos Santos Tese completa.pdf: 5987110 bytes, checksum: 97895c75dc86e94f121a9cd15cac48fd (MD5)Made available in DSpace on 2021-01-05T19:35:45Z (GMT). No. of bitstreams: 1 Ana Beatriz Vargas dos Santos Tese completa.pdf: 5987110 bytes, checksum: 97895c75dc86e94f121a9cd15cac48fd (MD5) Previous issue date: 2018-09-17Conselho Nacional de Desenvolvimento Científico e Tecnológicoapplication/pdfporUniversidade do Estado do Rio de JaneiroPrograma de Pós-Graduação em Ciências MédicasUERJBRCentro Biomédico::Faculdade de Ciências MédicasGoutChronic kidney diseaseKnowledgeTreatmentAllopurinolUrate-lowering therapyGotaDoença renal crônicaConhecimentoTratamentoAlopurinolTerapia hipouricemianteTerapia uricorredutoraGota (Doença)Artrite GotosaDoenças reumáticas TratamentoAlopurinolHiperucemiaCNPQ::CIENCIAS DA SAUDE::SAUDE COLETIVAAvaliação do manejo da gota, com foco especial no contexto da doença renal crônicaEvaluation of gout management, with a special focus on the context of chronic kidney diseaseinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisinfo:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da UERJinstname:Universidade do Estado do Rio de Janeiro (UERJ)instacron:UERJORIGINALAna Beatriz Vargas dos Santos Tese completa.pdfapplication/pdf5987110http://www.bdtd.uerj.br/bitstream/1/8539/1/Ana+Beatriz+Vargas+dos+Santos+Tese+completa.pdf97895c75dc86e94f121a9cd15cac48fdMD511/85392024-02-26 16:00:08.89oai:www.bdtd.uerj.br:1/8539Biblioteca Digital de Teses e Dissertaçõeshttp://www.bdtd.uerj.br/PUBhttps://www.bdtd.uerj.br:8443/oai/requestbdtd.suporte@uerj.bropendoar:29032024-02-26T19:00:08Biblioteca Digital de Teses e Dissertações da UERJ - Universidade do Estado do Rio de Janeiro (UERJ)false |
dc.title.por.fl_str_mv |
Avaliação do manejo da gota, com foco especial no contexto da doença renal crônica |
dc.title.alternative.eng.fl_str_mv |
Evaluation of gout management, with a special focus on the context of chronic kidney disease |
title |
Avaliação do manejo da gota, com foco especial no contexto da doença renal crônica |
spellingShingle |
Avaliação do manejo da gota, com foco especial no contexto da doença renal crônica Santos, Ana Beatriz Vargas dos Gout Chronic kidney disease Knowledge Treatment Allopurinol Urate-lowering therapy Gota Doença renal crônica Conhecimento Tratamento Alopurinol Terapia hipouricemiante Terapia uricorredutora Gota (Doença) Artrite Gotosa Doenças reumáticas Tratamento Alopurinol Hiperucemia CNPQ::CIENCIAS DA SAUDE::SAUDE COLETIVA |
title_short |
Avaliação do manejo da gota, com foco especial no contexto da doença renal crônica |
title_full |
Avaliação do manejo da gota, com foco especial no contexto da doença renal crônica |
title_fullStr |
Avaliação do manejo da gota, com foco especial no contexto da doença renal crônica |
title_full_unstemmed |
Avaliação do manejo da gota, com foco especial no contexto da doença renal crônica |
title_sort |
Avaliação do manejo da gota, com foco especial no contexto da doença renal crônica |
author |
Santos, Ana Beatriz Vargas dos |
author_facet |
Santos, Ana Beatriz Vargas dos |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Pinheiro, Geraldo da Rocha Castelar |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/7536115815141738 |
dc.contributor.referee1.fl_str_mv |
Klumb, Evandro Mendes |
dc.contributor.referee1Lattes.fl_str_mv |
http://lattes.cnpq.br/3194331454644472 |
dc.contributor.referee2.fl_str_mv |
Suassuna, José Hermógenes Rocco |
dc.contributor.referee2Lattes.fl_str_mv |
http://lattes.cnpq.br/0065381779108423 |
dc.contributor.referee3.fl_str_mv |
Azevedo, Valderilio Feijó |
dc.contributor.referee3Lattes.fl_str_mv |
http://lattes.cnpq.br/0102178796973154 |
dc.contributor.referee4.fl_str_mv |
Cunha, Geraldo Marcelo da |
dc.contributor.referee4Lattes.fl_str_mv |
http://lattes.cnpq.br/4238249453763776 |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/4974621854484453 |
dc.contributor.author.fl_str_mv |
Santos, Ana Beatriz Vargas dos |
contributor_str_mv |
Pinheiro, Geraldo da Rocha Castelar Klumb, Evandro Mendes Suassuna, José Hermógenes Rocco Azevedo, Valderilio Feijó Cunha, Geraldo Marcelo da |
dc.subject.eng.fl_str_mv |
Gout Chronic kidney disease Knowledge Treatment Allopurinol Urate-lowering therapy |
topic |
Gout Chronic kidney disease Knowledge Treatment Allopurinol Urate-lowering therapy Gota Doença renal crônica Conhecimento Tratamento Alopurinol Terapia hipouricemiante Terapia uricorredutora Gota (Doença) Artrite Gotosa Doenças reumáticas Tratamento Alopurinol Hiperucemia CNPQ::CIENCIAS DA SAUDE::SAUDE COLETIVA |
dc.subject.por.fl_str_mv |
Gota Doença renal crônica Conhecimento Tratamento Alopurinol Terapia hipouricemiante Terapia uricorredutora Gota (Doença) Artrite Gotosa Doenças reumáticas Tratamento Alopurinol Hiperucemia |
dc.subject.cnpq.fl_str_mv |
CNPQ::CIENCIAS DA SAUDE::SAUDE COLETIVA |
description |
Gout is one of the most prevalent inflammatory arthritis among adults less common than osteoarthritis and calcium pyrophosphate deposition disease only. It is characterized by recurrent flares of very painful acute arthritis and may present macroscopic deposits of uric acid (tophi). Although it was first described over 4,000 years ago, has defined etiology, relatively easy diagnosis and available treatment, gout is still inadequately treated and it is associated with high morbimortality and negative effect on quality of life. This thesis aimed to investigate the management of gout, stressing the context of chronic kidney disease. Specific objectives were: (i) to describe and analyze current practices of gout management among Brazilian rheumatologists (study 1); (ii) to review the management of gout and hyperuricemia in the context of chronic kidney disease (study 2), (iii) to review the relation between hyperuricemia and urate-lowering therapy and renal outcomes (study 2), and (iv) to evaluate the effect of allopurinol on kidney function of individuals with gout (study 3). Study 1 was a survey on the treatment of gout in a random sample of 309 Brazilian rheumatologists. Study 2 was a narrative review on the management of gout in the context of chronic kidney disease and the effects of hyperuricemia and urate-lowering therapy on kidney function. In study 3, we investigated a cohort of 9520 adults residents in the United Kingdom with recently-diagnosed gout, stratified by time, matched by propensity score. We evaluated the effects of the incident use of ≥300 mg/day of allopurinol on the kidney function of patients without chronic kidney disease. Study 1 revealed that the Brazilian rheumatologists had unsatisfactory knowledge, especially the non-recognition of gouty tophi as an indication for urate-lowering therapy, the withdrawal of the urate-lowering therapy during a gout flare, the initial prescription of allopurinol in high doses and the non-recognition that urate-lowering therapy should be maintained indefinitely. In study 2, we synthesized the most updated recommendations on the management of urate-lowering therapy, anti-inflammatory prophylaxis and the treatment of gout flares. We also showed the deleterious effects of hyperuricemia and the potential benefits of urate-lowering therapy on kidney function. The results of the papers included in this review varied from a protective effect of the urate-lowering therapy to the non-identification of a significant association, with no article pointing out deleterious effect of the urate-lowering therapy on the kidneys. We identified large heterogeneity in the inclusion criteria of the participants, with few papers evaluating gout patients exclusively, and some methodological issues that could lead to biased findings. In Study 3 we identified a renoprotective effect of allopurinol, with a 13% reduction in the risk of developing chronic kidney disease stage ≥3. Considering the lack of knowledge about gout management, especially in patients with compromised kidney function, and in light of the body of evidence of the broad benefits of urate-lowering therapy, it is of great importance that continuing education programs about gout management are proposed to guarantee that patients receive a more adequate and complete treatment. |
publishDate |
2018 |
dc.date.issued.fl_str_mv |
2018-09-17 |
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2019-11-13 |
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2021-01-05T19:35:45Z |
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SANTOS, Ana Beatriz Vargas dos. Avaliação do manejo da gota, com foco especial no contexto da doença renal crônica. 2018. 174 f. Tese (Doutorado em Ciências Médicas) - Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2018. |
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http://www.bdtd.uerj.br/handle/1/8539 |
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SANTOS, Ana Beatriz Vargas dos. Avaliação do manejo da gota, com foco especial no contexto da doença renal crônica. 2018. 174 f. Tese (Doutorado em Ciências Médicas) - Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2018. |
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Centro Biomédico::Faculdade de Ciências Médicas |
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Universidade do Estado do Rio de Janeiro |
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