Avaliação de reações inflamatórias intestinais induzidas pelo metotrexato em pacientes com artrite reumatóide por meio da dosagem da calprotectina fecal
Tipo
TCC
Data de publicação
2024-06-06
Periódico
Citações (Scopus)
Autores
Schadeck, Emanueli Taíne
Borges, Henrique Lira
Borges, Henrique Lira
Orientador
Nisihara, Renato Mitsunori
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INTRODUÇÃO: A artrite reumatóide (AR) é uma doença autoimune que acomete
principalmente mulheres e possui repercussões nas articulações sinoviais e, também,
extra-articulares. Para tratamento da doença, a primeira linha de escolha, é o
metotrexato (MTX), que possui atividade imunomoduladora e anti-inflamatória.
Contudo, seus efeitos adversos possuem grande expressividade no trato
gastrointestinal, prejudicando o seguimento da terapêutica e qualidade de vida física
e mental dos pacientes em terapia com MTX. A inflamação intestinal cursa com
sintomas no sistema acometido, e ela pode ser monitorada por meio de um marcador
sensível: a calprotectina fecal (CF). OBJETIVOS: Avaliar a concentração de CF,
como marcador de inflamação intestinal, e correlacionar com os efeitos
gastrointestinais ocasionados pelo uso de MTX em pacientes com AR. MÉTODOS:
Foi realizado um estudo transversal analítico a partir da coleta de material fecal e
análise da gravidade de intolerância ao Metotrexato das pacientes com AR atendidas
no serviço de reumatologia de um hospital terciário de Curitiba-PR. RESULTADOS:
Das 73 pacientes da amostra (36 em uso de MTX e 37 controles), 15% apresentaram
concentrações de CF aumentadas. Em relação ao uso de MTX, observou-se que o
uso do medicamento está inversamente relacionado às concentrações de CF (p =
0,0137), e, ao se avaliar o tempo de doença e níveis de calprotectina, encontrou-se p
de 0,0343, indicando correlação com significância. Contudo, ao analisar os níveis de
CF encontrados e o questionário de queixas gastrointestinais aplicado às pacientes
não se encontrou valor de p que indique relevância estatística. Ainda, quando feita a
correlação dos valores de CF com os índices de atividade da AR, constatou-se que
não houve significância estatística. CONCLUSÃO: Pacientes em uso de MTX
apresentaram concentrações de CF significativamente menores do que aquelas que
não usaram, mas nota-se que isso não depende da dose e nem do tempo de uso.
Pacientes com maior tempo de doença apresentaram significativamente maiores
concentrações de CF. Não foi encontrada relação da CF com a atividade da doença
e com uso de outros medicamentos.
INTRODUCTION: Rheumatoid arthritis (RA) is an autoimmune disease that mainly affects women and has repercussions on synovial and extra-articular joints. To treat the disease, the first line of choice is methotrexate (MTX), which has immunomodulatory and anti-inflammatory activity. However, its adverse effects are highly significant in the gastrointestinal tract, impairing the follow-up of therapy and the physical and mental quality of life of patients undergoing MTX therapy. Intestinal inflammation presents symptoms in the affected system, and it can be monitored using a sensitive marker: fecal calprotectin (FC). OBJECTIVES: To evaluate the concentration of FC, as a marker of intestinal inflammation, and correlate it with the gastrointestinal effects caused by the use of MTX in patients with RA. METHODS: An analytical cross-sectional study was carried out by collecting fecal material and analyzing the severity of intolerance to Methotrexate in patients with RA treated at the rheumatology service of a tertiary hospital in Curitiba-PR. RESULTS: Of the 73 patients in the sample (36 using MTX and 37 controls), 15% had increased FC concentrations. Regarding the use of MTX, it was observed that the use of the medication is inversely related to FC concentrations (p = 0.0137), and, when evaluating the duration of the disease and calprotectin levels, a p of 0 was found. .0343, indicating correlation with significance. However, when analyzing the FC levels found and the gastrointestinal complaints questionnaire applied to the patients, no p-value was found to indicate statistical relevance. Furthermore, when the FC values were correlated with the RA activity indices, it was found that there was no statistical significance. CONCLUSION: Patients using MTX had significantly lower FC concentrations than those who did not use it, but it is noted that this does not depend on the dose or time of use. Patients with longer disease duration had significantly higher FC concentrations. No relationship was found between FC and disease activity or the use of other medications.
INTRODUCTION: Rheumatoid arthritis (RA) is an autoimmune disease that mainly affects women and has repercussions on synovial and extra-articular joints. To treat the disease, the first line of choice is methotrexate (MTX), which has immunomodulatory and anti-inflammatory activity. However, its adverse effects are highly significant in the gastrointestinal tract, impairing the follow-up of therapy and the physical and mental quality of life of patients undergoing MTX therapy. Intestinal inflammation presents symptoms in the affected system, and it can be monitored using a sensitive marker: fecal calprotectin (FC). OBJECTIVES: To evaluate the concentration of FC, as a marker of intestinal inflammation, and correlate it with the gastrointestinal effects caused by the use of MTX in patients with RA. METHODS: An analytical cross-sectional study was carried out by collecting fecal material and analyzing the severity of intolerance to Methotrexate in patients with RA treated at the rheumatology service of a tertiary hospital in Curitiba-PR. RESULTS: Of the 73 patients in the sample (36 using MTX and 37 controls), 15% had increased FC concentrations. Regarding the use of MTX, it was observed that the use of the medication is inversely related to FC concentrations (p = 0.0137), and, when evaluating the duration of the disease and calprotectin levels, a p of 0 was found. .0343, indicating correlation with significance. However, when analyzing the FC levels found and the gastrointestinal complaints questionnaire applied to the patients, no p-value was found to indicate statistical relevance. Furthermore, when the FC values were correlated with the RA activity indices, it was found that there was no statistical significance. CONCLUSION: Patients using MTX had significantly lower FC concentrations than those who did not use it, but it is noted that this does not depend on the dose or time of use. Patients with longer disease duration had significantly higher FC concentrations. No relationship was found between FC and disease activity or the use of other medications.
Descrição
Palavras-chave
artrite reumatóide , mucosite , biomarcador , rheumatoid arthritis , mucositis , biomarker