Quadro Clínico da Osteoartrite

Apresentação em tema: "Quadro Clínico da Osteoartrite"— Transcrição da apresentação:

1 Quadro Clínico da Osteoartrite
Mais comumente afetam as articulações das mãos, joelhos, quadris e coluna vertebral Sintomas comuns são a dor relacionada com o uso, rigidez matinal (geralmente dura menos de 30 minutos), fraqueza e instabilidade da articulação Sinais clínicos incluem inchaço, crepitação, inflamação localizada intermitente, movimento restrito, osteófitos e destruição do tecido do osso ou da articulação Dano articular de maneira assimétrica Exacerbação dos sintomas com atividade física ou abuso 5.1

2 Diagnosis of OA Patient history Physical examination
Laboratory evaluation Synovial fluid analysis and radiographic evaluation Diagnosis of OA and rheumatoid arthritis (RA) involves many of the same steps, which include employing specific clinical classification criteria provided by the American College of Rheumatology (ACR). These criteria include assessment of joint pain and mobility and as well as laboratory and radiographic findings.1-3 Laboratory tests used to diagnose OA include erythrocyte sedimentation rate (ESR) and rheumatoid factor (RF), which can be used to rule out other causes of pain. Synovial fluid analysis and radiographic evaluation can be used to confirm the diagnosis of OA.1 The pattern of joint involvement can help distinguish OA from RA. Joint involvement in OA is often asymmetrical, most frequently affecting weight-bearing joints. References: Lane NE, Thompson JM. Management of osteoarthritis in the primary-care setting: an evidence-based approach to treatment. Am J Med. 1997;103 (suppl 6A):25S-30S. Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31: American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines. Guidelines for the management of rheumatoid arthritis: 2002 update. Arthritis Rheum. 2002;46: Lane NE et al. Am J Med. 1997;103(suppl 6A):25S-30S. 5.2

3 COX-2 Therapy Benefit in OA
Relief of signs and symptoms Proven upper GI safety1 Excellent tolerability2 Simple dosing Clinical trials performed over the past 10 years, following the availability of COX-2 inhibitors, have found these agents to be useful in the treatment of OA. Their efficacy in relieving pain is comparable to that of other classes of pain-relief products, but their lack of adverse events, especially their low incidence of GI side effects, has made them especially attractive.1,2 This improved tolerability may enhance patient compliance3,4 and effectiveness,5 important aspects of long-term pain-management therapy. References: Weaver AL. Rofecoxib: clinical pharmacology and clinical experience. J Clin Ther. 2001;23: Markenson JA. The demographics of chronic pain management. J Pain Symptom Manage. 2002;24:S10-S17. Morris LS, Schulz RM. Medication compliance: the patient’s perspective. Clin Ther. 1993;15: American Academy of Pediatrics Periodic Survey of Fellows. Periodic Survey 44: Patient compliance with prescription regimens. Available at: Accessed January 16, 2003. Michaud K, Wolfe F, Pettitt, et al. Patients remain on COX-2 NSAIDs longer than non-specific NSAIDs: a measure of comparative drug effectiveness. Presented at: EULAR Annual Congress of Rheumatology; 2002; Stockholm, Sweden. 1. Weaver AL. J Clin Ther. 2001;23: 2. Markenson JA. J Pain Symptom Manage. 2002;24:S10-S17. 5.3

4 Artrite Reumatóide (AR)
A artrite reumatóide é uma doença multissistêmica, crônica com evolução em surtos de agudização, podendo afetar vários órgãos. Afeta cerca de 1% a 3% da população americana e mundial É uma doença auto-imune. Envolvimento articular simétrico Prevalência - a AR ocorre em todos os grupos étnicos e raciais. Atinge três vezes mais mulheres do que homens. Etiologia - causa desconhecida, mas acredita-se que fatores genéticos e ambientais estejam envolvidos. 5.4

5 Quadro Clínico da Artrite Reumatóide
Os sintomas são dor, rigidez matinal durando pelo menos 1 hora, nódulos reumatóides (colágeno). Os sinais são edema, sensibilidade articular, calor articular, níveis elevados de fator reumatóide (anti-corpo anti IGs), incapacidades funcionais. São afetadas inicialmente as articulações das mãos, pés, pulsos e joelhos e à medida que a AR se estabelece, as articulações dos cotovelos, ombros, tornozelos e quadris são envolvidas. 5.5

6 Diagnosis of RA Patient history Physical examination
Laboratory evaluation serum rheumatoid factor erythrocyte sedimentation rate C-reactive protein Radiographic evaluation Diagnosis of OA and RA involves many of the same steps, which include employing specific clinical classification criteria provided by the ACR. These criteria include assessment of joint pain and mobility, as well as laboratory and radiographic findings.1,2 Laboratory tests used to diagnose RA include complete blood count, platelet count, RF, and ESR or C-reactive protein. Radiographic evaluation can be helpful.2 The pattern of joint involvement can help distinguish RA from OA. The clinical presentation of RA involves joints on opposite sides of the body, referred to as a symmetrical pattern.1 Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31: American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines. Guidelines for the management of rheumatoid arthritis: 2002 update. Arthritis Rheum. 2002;46: 16:330-1 17:319 Arnett FC et al. Arthritis Rheum. 1988;31: ACR Subcommittee on RA Guidelines. Arthritis Rheum. 2002;46: 17:330-1 17:319 5.6

7 Common Instruments for Assessing Pain and Function in Arthritis Trials
Visual analog scale (VAS) for pain (OA) Western Ontario and McMaster Universities (WOMAC) osteoarthritis index ACR-20 responder index also ACR-50, ACR-70 Generic (SF-36, HAQ) 5:313 These are common instruments used to assess pain and function in arthritis trials. The commonly used visual analog scale is one of the easiest methods for assessing pain.1 Arthritis-specific validated instruments include the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)2 and the American College of Rheumatology (ACR) indexes.3 The Short-Form 36 is a generic quality-of-life instrument that is used to assess pain in patients with OA. In a recent study that compared the responsiveness of the SF-36 with that of the WOMAC index, researchers found that both scales detected improvement in pain in patients undergoing treatment for OA, but that the WOMAC scale was more sensitive in detecting improvement in patient functionality.4 The Health Assessment Questionnaire (HAQ) is another generic quality-of-life instrument that includes pain components.5 Chapman CR, Syrjala KL. Measurement of pain. In: Loeser JD, Butler SH, Chapman CR, et al, eds. Bonica’s Management of Pain. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2001: Bellamy N, Buchanan WW, Goldsmith CH, et al. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15: Felson DT, Anderson JJ, Boers M, et al. American College of Rheumatology. Preliminary definition of improvement in rheumatoid arthritis. Arthritis Rheum. 1995;38: Angst F, Aeschlimann A, Steiner W, et al. Responsiveness of the WOMAC osteoarthritis index as compared with the SF-36 in patients with osteoarthritis of the legs undergoing a comprehensive rehabilitation intervention. Ann Rheum Dis. 2001;60: Ziebland S, Fitzpatrick R, Jenkinson C, et al. Comparison of two approaches to measuring change in health status in rheumatoid arthritis: the Health Assessment Questionnaire (HAQ) and modified HAQ. Ann Rheum Dis. 1992;51: 5:313 8:1834 9:732 6:834 10:1203 5.7