Compração de pacientes com espondiloartrite com e sem uveíte anterior em hospital de referência
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Tipo
TCC
Data de publicação
2023-11-27
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Citações (Scopus)
Autores
Piccini, Bruno Vitório de Oliveira
Silva, Nathaly Cristina
Silva, Nathaly Cristina
Orientador
Skare, Thelma Larocca
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Introdução: A espondiloartrite (EpA) compreende um grupo de doenças inflamatórias que atingem as articulações e a coluna vertebral, divididas em: espondilite anquilosante, artrite reativa, artrite psoriática, artrite associada à doença inflamatória intestinal e espondiloartrite indiferenciada. As manifestações clínicas principais são: lombalgia inflamatória, artrite periférica, entesite e uveíte anterior. A etiologia e fisiopatologia exata da espondiloartrite ainda é desconhecida, mas a principal teoria está atrelada ao marcador genético HLA-B27, relacionada à EpA e à uveíte anterior aguda (UAA). A UAA é a manifestação clínica extra-articular mais comum da EpA, sendo que o diagnóstico precoce da EpA pode ser relacionada ao aparecimento de UAA. Se pacientes com EpA e UAA apresentam um fenótipo especial da doença é pouco estudado em nosso meio. Objetivos: comparar o perfil clínico de pacientes com EpA com uveíte e sem uveíte anterior. Metodologia: trata-se de um estudo retrospectivo onde os dados foram coletados a partir da análise de 140 prontuários de pacientes diagnosticados com EpA no ambulatório de Reumatologia do Hospital Universitário Evangélico Mackenzie (HUEM), de janeiro de 2012 a dezembro de 2022. Foram coletados dados demográficos, clínicos e de HLA B27. A seguir os pacientes com e sem uveíte anterior foram comparados entre si. Resultados: Dos 140 pacientes, 59 eram do sexo feminino e 81 do sexo masculino. A uveíte estava presente em 25%. Pacientes com UAA tinham menor idade ao diagnóstico (p=0.02), eram mais do subtipo espondilite anquilosante (p<0.0001) e tinham menos manifestações cutâneas (p=0.001) e menos artrite periférica (p=0.003). O HLA B27 era mais encontrado nos pacientes com uveíte (p=0.001). Conclusões: A presença de UAA marca um fenótipo especial de EpA onde a doença tem um diagnóstico mais precoce, o HLA B27 é mais comum e existem menos alterações cutâneas e menos alterações articulares periféricas.
Introduction: Spondyloarthritis (SpA) comprises a group of inflammatory diseases that affect the joints and spine, divided into: ankylosing spondylitis, reactive arthritis, psoriatic arthritis, arthritis associated with inflammatory bowel disease and undifferentiated spondyloarthritis. The main clinical manifestations are: inflammatory low back pain, peripheral arthritis, enthesitis and anterior uveitis. The exact etiology and pathophysiology of spondyloarthritis is still unknown, but the main theory is linked to the genetic marker HLA-B27, related to EpA and acute anterior uveitis (UAA). UAA is the most common extra-articular clinical manifestation of SpA, and the early diagnosis of SpA may be related to the onset of UAA. Whether patients with SpA and UAA have a special phenotype of the disease is little studied in our country. Objectives: To compare the clinical profile of patients with SpA with uveitis and those without anterior uveitis. Methodology: this is a retrospective study where data were collected from the analysis of 140 medical records of patients diagnosed with SpA at the Rheumatology outpatient clinic of the Mackenzie Evangelical University Hospital (HUEM), from January 2012 to December 2022. Demographic, clinical, and HLA B27 data were collected. Next, patients with and without anterior uveitis were compared with each other. Results: Of the 140 patients, 59 were female and 81 were male. Uveitis was present in 25%. Patients with UAA were younger at diagnosis (p=0.02), were more of the ankylosing spondylitis subtype (p<0.0001) and had fewer cutaneous manifestations (p=0.001) and less peripheral arthritis (p=0.003). HLA B27 was more commonly found in patients with uveitis (p=0.001). Conclusions: The presence of UAA marks a special phenotype of EpA where the disease has an earlier diagnosis, HLA B27 is more common and there are fewer cutaneous changes and fewer peripheral joint changes.
Introduction: Spondyloarthritis (SpA) comprises a group of inflammatory diseases that affect the joints and spine, divided into: ankylosing spondylitis, reactive arthritis, psoriatic arthritis, arthritis associated with inflammatory bowel disease and undifferentiated spondyloarthritis. The main clinical manifestations are: inflammatory low back pain, peripheral arthritis, enthesitis and anterior uveitis. The exact etiology and pathophysiology of spondyloarthritis is still unknown, but the main theory is linked to the genetic marker HLA-B27, related to EpA and acute anterior uveitis (UAA). UAA is the most common extra-articular clinical manifestation of SpA, and the early diagnosis of SpA may be related to the onset of UAA. Whether patients with SpA and UAA have a special phenotype of the disease is little studied in our country. Objectives: To compare the clinical profile of patients with SpA with uveitis and those without anterior uveitis. Methodology: this is a retrospective study where data were collected from the analysis of 140 medical records of patients diagnosed with SpA at the Rheumatology outpatient clinic of the Mackenzie Evangelical University Hospital (HUEM), from January 2012 to December 2022. Demographic, clinical, and HLA B27 data were collected. Next, patients with and without anterior uveitis were compared with each other. Results: Of the 140 patients, 59 were female and 81 were male. Uveitis was present in 25%. Patients with UAA were younger at diagnosis (p=0.02), were more of the ankylosing spondylitis subtype (p<0.0001) and had fewer cutaneous manifestations (p=0.001) and less peripheral arthritis (p=0.003). HLA B27 was more commonly found in patients with uveitis (p=0.001). Conclusions: The presence of UAA marks a special phenotype of EpA where the disease has an earlier diagnosis, HLA B27 is more common and there are fewer cutaneous changes and fewer peripheral joint changes.
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Palavras-chave
espondiloartrite axial , espondilite , uveíte anterior , antígeno HLA-B27 , axial spondyloarthritis , spondylitis , uveitis, anterior , HLA-B27 antigen