Análise das alterações de mecânica respiratória por oscilações forçadas em pacientes com artrite reumatoide: diagnóstico precoce e associação das anormalidades com o tempo de diagnóstico de doença, relato de dispneia e fator reumatoide

• Autor(a) principal: Faria, Alvaro Camilo Dias
• Data de Publicação: 2014
• 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/1/12676
• topic: Forced oscillations; Rheumatoid Arthritis; Early changes; Time of Illness; Dyspnea; Rheumatoid Factor; Oscilações forçadas; Artrite Reumatoide; Alterações Precoces; Tempo de Doença; Dispneia; Fator Reumatoide; Artrite reumatoide; Artrite Reumatoide Complicações; Mecânica Respiratória; Mecânica Respiratória Fisiologia; Fator Reumatoide Fisiologia; Dispneia Fisiopatologia; CNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::PNEUMOLOGIA

The main changes associated with Rheumatoid Arthritis (RA) are in the joint; however, systemic manifestations are also found in organs such as lung and heart. They contribute significantly to morbidity and mortality in patients with RA, pulmonary complications are common and account for 10% to 15% of all mortality. Although pulmonary involvement is a frequent manifestation in RA, the prevalence and nature of rheumatoid lung disease has not been precisely established. This thesis aimed: (1) assess the clinical potential use of the Forced Oscillation Technique (FOT) in early diagnosis of respiratory changes in RA (2) Analyze the effects of disease duration, (3) presence of dyspnea and (4) the rheumatoid factor (RF) on respiratory biomechanics of patients with RA. Through FOT and spirometry tests, 88 patients were studied, and only 72 participated in the survey, divided into the following groups according to disease duration: patients under 5 years of disease, RA5 (n=14); patients with 6-10 years of disease, RA6-10 (n=16); patients with 11-15 years of disease, RA11-15 (n=15); and patients over 16 years of disease, AR16 (n=20). In the related report of dyspnea analyzes, we used 15 patients without symptoms (SA) and 15 patients with symptoms (S). For the study of RF: 17 with absence of RF and 17 with the presence of RF. We divided the study methodology of changes in respiratory mechanics in four phases: analysis of early changes (n = 20); effect of duration of disease (n = 72); effect reported dyspnea (n = 30); effect of rheumatoid factor (n = 34). The parameters analyzed were the impedance curves of the respiratory system, the extrapolated intercept resistance (R0), resistance at 4 Hz (Rrs4Hz), slope of the resistance curve (S), medium resistance (Rm), dynamic respiratory compliance (Cdyn), resonance frequency (fr), average reactance (Xm) and the impedance modulus at 4 Hz (Zrs4Hz). The control group (CG) was composed of 20 individuals. The results indicate that the increased length of the RA results in increased mechanical resistance and the total load and decreased dynamic compliance of the respiratory system. FOT parameters identified changes between the control group and the group with shorter disease while spirometry remained unchanged. The initial impact of RA were also well described even in the absence of respiratory symptoms. These early changes were identified by TOF featuring high accuracy, while again spirometry was less efficient. In RA patients with absence of autoantibody RF, respiratory mechanics are altered with increasing resistance (p<0.00001) and Zrs4Hz (p<0.00001), and reduced homogeneity (p<0.04) and Cdin (p<0.00001). The presence of autoantibody RF introduces even more significant impact of respiratory mechanics, demonstrating its influence on resistive and reactive properties of the respiratory system.