Condutas usuais entre os reumatologistas brasileiros: levantamento nacional

Detalhes bibliográficos
Autor(a) principal: Medeiros, Marta M. C.
Data de Publicação: 2006
Outros Autores: Ferraz, Marcos Bosi [UNIFESP], Vilar, Maria José Pereira, Santiago, Mittermayer Barreto, Xavier, Ricardo Machado, Levy, Roger Abramino, Ciconelli, Rozana Mesquita [UNIFESP], Kowalski, Sérgio Candido [UNIFESP]
Tipo de documento: Artigo
Idioma: por
Título da fonte: Repositório Institucional da UNIFESP
Texto Completo: http://dx.doi.org/10.1590/S0482-50042006000200002
http://repositorio.unifesp.br/handle/11600/3013
Resumo: OBJECTIVE: Evaluate routine clinical practices of Brazilian rheumatologists. METHOD: Virtual clinical scenarios representing a range of rheumatological practical situations were sent by mail to 831 specialists certified by the Brazilian Society of Rheumatology (SBR) with postage-paid envelopes for reply. RESULTS: Only 21.4% of the questionnaires were returned. The average age of responding rheumatologists was 42.7 years (SD=11.7), with an average time since graduation from medical school of 19.8 years (SD=10.1). In a clinical scenario describing early active rheumatoid arthritis most respondents (84.7%) chose to initiate treatment with prednisone or prednisolone. The most chosen disease modifying antirheumatic drugs were methotrexate (84,2%) and chloroquine (63.8%). Four rheumatologists (2.8%) indicated biological agents (infliximab and etanercept) as their initial choice of treatment. Prophylaxis for corticoid-induced osteoporosis and calcium and vitamin D supplementation were recommended by only 61.2% and 46.5% of the respondents, respectively. In a clinical scenario describing systemic lupus erythematosus, almost all doctors prescribed oral corticoids (93.7%), chloroquine (92.5%) and photoprotection (93.7%). In the presence of lupus nephritis with unimpaired renal function and normal blood pressure levels, the most frequently adopted management was pulse therapy with corticoids (47.7%) or high doses of oral prednisone. Pulsetherapy with cyclophosphamide was indicated by 34.6% of the respondents. In a clinical scenario describing acute mechanical back pain without alarming signs, 55.4% stated that they would request no laboratory examinations on the first encounter and the main treatments of choice were non-hormonal antiinflammatory drugs (89.3%), muscle relaxant drugs (72.9%) and physical therapy (33.3%). Bed rest was recommended by 31.6% of the respondents. In a clinical scenario describing chronic back pain with recent X-ray showing first degree spondylolisthesis and disc arthrosis, 39.6% of the rheumatologists stated that they would not request additional examinations, while 26.2% and 24.4% would request computer tomography scans and magnetic resonance scans, respectively. The most frequently prescribed treatments were physical therapy (75.1%), muscle relaxant drugs (48.5%), RPG (45.6%), physical exercise (41%), Cox-2-selective non-hormonal antiinflammatory drugs (40.5%), amitriptyline (35.3%) and opioid analgesics (34.7%). The questionnaire also included scenarios describing knee arthrosis and shoulder pain. CONCLUSION: The low rate of response from rheumatologists may be associated with aspects of Brazilian culture. In fact, respondents displayed a very similar profile throughout the country. Most of the prescribed treatments agree with available evidence and reflect a homogeneous approach to rheumatological disease among professionals. However, although the present study has provided interesting information regarding clinical practices, the small number of respondents may not be particularly representative of the population of Brazilian rheumatologists.
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spelling Condutas usuais entre os reumatologistas brasileiros: levantamento nacionalRoutine clinical practices of Brazilian rheumatologists: national overviewClinical managementrheumatic diseasescondutas práticasdoenças reumáticasOBJECTIVE: Evaluate routine clinical practices of Brazilian rheumatologists. METHOD: Virtual clinical scenarios representing a range of rheumatological practical situations were sent by mail to 831 specialists certified by the Brazilian Society of Rheumatology (SBR) with postage-paid envelopes for reply. RESULTS: Only 21.4% of the questionnaires were returned. The average age of responding rheumatologists was 42.7 years (SD=11.7), with an average time since graduation from medical school of 19.8 years (SD=10.1). In a clinical scenario describing early active rheumatoid arthritis most respondents (84.7%) chose to initiate treatment with prednisone or prednisolone. The most chosen disease modifying antirheumatic drugs were methotrexate (84,2%) and chloroquine (63.8%). Four rheumatologists (2.8%) indicated biological agents (infliximab and etanercept) as their initial choice of treatment. Prophylaxis for corticoid-induced osteoporosis and calcium and vitamin D supplementation were recommended by only 61.2% and 46.5% of the respondents, respectively. In a clinical scenario describing systemic lupus erythematosus, almost all doctors prescribed oral corticoids (93.7%), chloroquine (92.5%) and photoprotection (93.7%). In the presence of lupus nephritis with unimpaired renal function and normal blood pressure levels, the most frequently adopted management was pulse therapy with corticoids (47.7%) or high doses of oral prednisone. Pulsetherapy with cyclophosphamide was indicated by 34.6% of the respondents. In a clinical scenario describing acute mechanical back pain without alarming signs, 55.4% stated that they would request no laboratory examinations on the first encounter and the main treatments of choice were non-hormonal antiinflammatory drugs (89.3%), muscle relaxant drugs (72.9%) and physical therapy (33.3%). Bed rest was recommended by 31.6% of the respondents. In a clinical scenario describing chronic back pain with recent X-ray showing first degree spondylolisthesis and disc arthrosis, 39.6% of the rheumatologists stated that they would not request additional examinations, while 26.2% and 24.4% would request computer tomography scans and magnetic resonance scans, respectively. The most frequently prescribed treatments were physical therapy (75.1%), muscle relaxant drugs (48.5%), RPG (45.6%), physical exercise (41%), Cox-2-selective non-hormonal antiinflammatory drugs (40.5%), amitriptyline (35.3%) and opioid analgesics (34.7%). The questionnaire also included scenarios describing knee arthrosis and shoulder pain. CONCLUSION: The low rate of response from rheumatologists may be associated with aspects of Brazilian culture. In fact, respondents displayed a very similar profile throughout the country. Most of the prescribed treatments agree with available evidence and reflect a homogeneous approach to rheumatological disease among professionals. However, although the present study has provided interesting information regarding clinical practices, the small number of respondents may not be particularly representative of the population of Brazilian rheumatologists.OBJETIVO: avaliar condutas tomadas pelos reumatologistas de todo Brasil frente a situações clínicas comuns na prática do dia-a-dia. MÉTODO: cenários clínicos fictícios sobre várias doenças reumáticas foram montados, com perguntas objetivas acerca do tratamento. Os questionários foram enviados aos 831 sócios com títulos de especialistas pela Sociedade Brasileira de Reumatologia (SBR), com envelope selado para envio das respostas. RESULTADOS: a taxa média de devolução dos questionários foi de apenas 21,4%. A média de idade (DP) dos reumatologistas respondedores foi de 42,7 anos (DP=11,7), com tempo médio de formados de 19,8 anos (DP=10,1). No cenário clínico sobre artrite reumatóide (AR) de início recente em atividade, a maioria dos colegas (84,7%) tratava inicialmente o paciente com prednisona ou prednisolona. As drogas modificadoras da doença mais escolhidas foram metotrexato (84,2%) e cloroquina (63,8%). Quatro médicos (2,8%) escolheram os agentes biológicos (infliximabe e etanercepte) como droga de primeira escolha no tratamento inicial da doença. A profilaxia para osteoporose induzida pelo corticóide com suplementação de cálcio e vitamina D só foi orientada por 61,2% e 46,5% dos reumatologistas, respectivamente. No cenário clínico de um paciente com lúpus eritematoso sistêmico (LES), a grande maioria dos colegas optou pelo tratamento com corticóide oral (93,7%), cloroquina (92,5%) e fotoproteção (93,7%). Na presença de nefrite lúpica caracterizada com preservação da função renal e níveis pressóricos normais, a conduta mais escolhida foi pulsoterapia de corticóide (47,7%) ou prednisona oral em altas doses. Pulsoterapia de ciclofosfamida foi escolhida por 34,6% dos reumatologistas. No cenário sobre lombalgia aguda mecânico-postural, sem sinais de alarme, 55,4% dos colegas não solicitavam nenhum exame na abordagem inicial e as drogas mais escolhidas para o tratamento foram: antiinflamatórios não-hormonais (AINHs) (89,3%), relaxante muscular (72,9%), fisioterapia (33,3%). O repouso no leito foi orientado por 31,6% dos especialistas. Num caso de lombalgia crônica com raio X recente mostrando espondilolistese grau 1 e discoartrose, 39,6% dos reumatologistas não solicitavam nenhum exame adicional, enquanto 26,2% e 24,4% solicitavam tomografia computadorizada (TC) e ressonância nuclear magnética (RNM), respectivamente. As condutas mais indicadas nesse caso foram: fisioterapia (75,1%), relaxante muscular (48,5%), RPG (45,6%), exercícios físicos (41%), AINH seletivo da Cox-2 (40,5%), amitriptilina (35,3%), analgésicos opióides (34,7%). Outros cenários de artrose de joelho e ombro doloroso foram apresentados. CONCLUSÕES: a baixa taxa de devolução dos questionários pode refletir uma prática ainda não-incorporada na nossa cultura. O perfil dos reumatologistas respondedores é muito semelhante entre as regiões. A maioria das condutas escolhidas está de acordo com as melhores evidências disponíveis, refletindo uma homogeneidade de abordagem terapêutica entre os reumatologistas. Embora este estudo traga importantes dados sobre a prática reumatológica, pode não ser representativo da população de reumatologistas brasileiros, tendo em vista o baixo percentual de respondedores.Universidade Federal do Ceará Faculdade de MedicinaDepartamento de MedicinaUniversidade Federal do Rio Grande do NorteEscola Bahiana de Medicina e Saúde PúblicaUniversidade Federal do Rio Grande do SulUniversidade Estadual do Rio de Janeiro Faculdade de MedicinaUniversidade Federal de São Paulo (UNIFESP)UNIFESP Centro Paulista de Economia da SaúdeUniversidade de São Paulo Faculdade de MedicinaUNIFESP, Centro Paulista de Economia da SaúdeSciELOSociedade Brasileira de ReumatologiaUniversidade Federal do Ceará Faculdade de MedicinaDepartamento de MedicinaUniversidade Federal do Rio Grande do NorteEscola Bahiana de Medicina e Saúde PúblicaUniversidade Federal do Rio Grande do SulUniversidade Estadual do Rio de Janeiro Faculdade de MedicinaUniversidade Federal de São Paulo (UNIFESP)Universidade de São Paulo (USP)Medeiros, Marta M. C.Ferraz, Marcos Bosi [UNIFESP]Vilar, Maria José PereiraSantiago, Mittermayer BarretoXavier, Ricardo MachadoLevy, Roger AbraminoCiconelli, Rozana Mesquita [UNIFESP]Kowalski, Sérgio Candido [UNIFESP]2015-06-14T13:32:03Z2015-06-14T13:32:03Z2006-04-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion82-92application/pdfhttp://dx.doi.org/10.1590/S0482-50042006000200002Revista Brasileira de Reumatologia. Sociedade Brasileira de Reumatologia, v. 46, n. 2, p. 82-92, 2006.10.1590/S0482-50042006000200002S0482-50042006000200002.pdf0482-5004S0482-50042006000200002http://repositorio.unifesp.br/handle/11600/3013porRevista Brasileira de Reumatologiainfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP2024-07-28T10:39:30Zoai:repositorio.unifesp.br/:11600/3013Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestbiblioteca.csp@unifesp.bropendoar:34652024-07-28T10:39:30Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false
dc.title.none.fl_str_mv Condutas usuais entre os reumatologistas brasileiros: levantamento nacional
Routine clinical practices of Brazilian rheumatologists: national overview
title Condutas usuais entre os reumatologistas brasileiros: levantamento nacional
spellingShingle Condutas usuais entre os reumatologistas brasileiros: levantamento nacional
Medeiros, Marta M. C.
Clinical management
rheumatic diseases
condutas práticas
doenças reumáticas
title_short Condutas usuais entre os reumatologistas brasileiros: levantamento nacional
title_full Condutas usuais entre os reumatologistas brasileiros: levantamento nacional
title_fullStr Condutas usuais entre os reumatologistas brasileiros: levantamento nacional
title_full_unstemmed Condutas usuais entre os reumatologistas brasileiros: levantamento nacional
title_sort Condutas usuais entre os reumatologistas brasileiros: levantamento nacional
author Medeiros, Marta M. C.
author_facet Medeiros, Marta M. C.
Ferraz, Marcos Bosi [UNIFESP]
Vilar, Maria José Pereira
Santiago, Mittermayer Barreto
Xavier, Ricardo Machado
Levy, Roger Abramino
Ciconelli, Rozana Mesquita [UNIFESP]
Kowalski, Sérgio Candido [UNIFESP]
author_role author
author2 Ferraz, Marcos Bosi [UNIFESP]
Vilar, Maria José Pereira
Santiago, Mittermayer Barreto
Xavier, Ricardo Machado
Levy, Roger Abramino
Ciconelli, Rozana Mesquita [UNIFESP]
Kowalski, Sérgio Candido [UNIFESP]
author2_role author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Universidade Federal do Ceará Faculdade de Medicina
Departamento de Medicina
Universidade Federal do Rio Grande do Norte
Escola Bahiana de Medicina e Saúde Pública
Universidade Federal do Rio Grande do Sul
Universidade Estadual do Rio de Janeiro Faculdade de Medicina
Universidade Federal de São Paulo (UNIFESP)
Universidade de São Paulo (USP)
dc.contributor.author.fl_str_mv Medeiros, Marta M. C.
Ferraz, Marcos Bosi [UNIFESP]
Vilar, Maria José Pereira
Santiago, Mittermayer Barreto
Xavier, Ricardo Machado
Levy, Roger Abramino
Ciconelli, Rozana Mesquita [UNIFESP]
Kowalski, Sérgio Candido [UNIFESP]
dc.subject.por.fl_str_mv Clinical management
rheumatic diseases
condutas práticas
doenças reumáticas
topic Clinical management
rheumatic diseases
condutas práticas
doenças reumáticas
description OBJECTIVE: Evaluate routine clinical practices of Brazilian rheumatologists. METHOD: Virtual clinical scenarios representing a range of rheumatological practical situations were sent by mail to 831 specialists certified by the Brazilian Society of Rheumatology (SBR) with postage-paid envelopes for reply. RESULTS: Only 21.4% of the questionnaires were returned. The average age of responding rheumatologists was 42.7 years (SD=11.7), with an average time since graduation from medical school of 19.8 years (SD=10.1). In a clinical scenario describing early active rheumatoid arthritis most respondents (84.7%) chose to initiate treatment with prednisone or prednisolone. The most chosen disease modifying antirheumatic drugs were methotrexate (84,2%) and chloroquine (63.8%). Four rheumatologists (2.8%) indicated biological agents (infliximab and etanercept) as their initial choice of treatment. Prophylaxis for corticoid-induced osteoporosis and calcium and vitamin D supplementation were recommended by only 61.2% and 46.5% of the respondents, respectively. In a clinical scenario describing systemic lupus erythematosus, almost all doctors prescribed oral corticoids (93.7%), chloroquine (92.5%) and photoprotection (93.7%). In the presence of lupus nephritis with unimpaired renal function and normal blood pressure levels, the most frequently adopted management was pulse therapy with corticoids (47.7%) or high doses of oral prednisone. Pulsetherapy with cyclophosphamide was indicated by 34.6% of the respondents. In a clinical scenario describing acute mechanical back pain without alarming signs, 55.4% stated that they would request no laboratory examinations on the first encounter and the main treatments of choice were non-hormonal antiinflammatory drugs (89.3%), muscle relaxant drugs (72.9%) and physical therapy (33.3%). Bed rest was recommended by 31.6% of the respondents. In a clinical scenario describing chronic back pain with recent X-ray showing first degree spondylolisthesis and disc arthrosis, 39.6% of the rheumatologists stated that they would not request additional examinations, while 26.2% and 24.4% would request computer tomography scans and magnetic resonance scans, respectively. The most frequently prescribed treatments were physical therapy (75.1%), muscle relaxant drugs (48.5%), RPG (45.6%), physical exercise (41%), Cox-2-selective non-hormonal antiinflammatory drugs (40.5%), amitriptyline (35.3%) and opioid analgesics (34.7%). The questionnaire also included scenarios describing knee arthrosis and shoulder pain. CONCLUSION: The low rate of response from rheumatologists may be associated with aspects of Brazilian culture. In fact, respondents displayed a very similar profile throughout the country. Most of the prescribed treatments agree with available evidence and reflect a homogeneous approach to rheumatological disease among professionals. However, although the present study has provided interesting information regarding clinical practices, the small number of respondents may not be particularly representative of the population of Brazilian rheumatologists.
publishDate 2006
dc.date.none.fl_str_mv 2006-04-01
2015-06-14T13:32:03Z
2015-06-14T13:32:03Z
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://dx.doi.org/10.1590/S0482-50042006000200002
Revista Brasileira de Reumatologia. Sociedade Brasileira de Reumatologia, v. 46, n. 2, p. 82-92, 2006.
10.1590/S0482-50042006000200002
S0482-50042006000200002.pdf
0482-5004
S0482-50042006000200002
http://repositorio.unifesp.br/handle/11600/3013
url http://dx.doi.org/10.1590/S0482-50042006000200002
http://repositorio.unifesp.br/handle/11600/3013
identifier_str_mv Revista Brasileira de Reumatologia. Sociedade Brasileira de Reumatologia, v. 46, n. 2, p. 82-92, 2006.
10.1590/S0482-50042006000200002
S0482-50042006000200002.pdf
0482-5004
S0482-50042006000200002
dc.language.iso.fl_str_mv por
language por
dc.relation.none.fl_str_mv Revista Brasileira de Reumatologia
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 82-92
application/pdf
dc.publisher.none.fl_str_mv Sociedade Brasileira de Reumatologia
publisher.none.fl_str_mv Sociedade Brasileira de Reumatologia
dc.source.none.fl_str_mv reponame:Repositório Institucional da UNIFESP
instname:Universidade Federal de São Paulo (UNIFESP)
instacron:UNIFESP
instname_str Universidade Federal de São Paulo (UNIFESP)
instacron_str UNIFESP
institution UNIFESP
reponame_str Repositório Institucional da UNIFESP
collection Repositório Institucional da UNIFESP
repository.name.fl_str_mv Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)
repository.mail.fl_str_mv biblioteca.csp@unifesp.br
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