Caracterização dos pacientes com diagnóstico de artrite reumatóide juvenildo Serviço de Reumatologia do Hospital das Clínicas da UFMG, com avaliação dos fatores determinantes do prognóstico

• Ano de defesa: 2006
• Autor(a) principal: Flavia Patricia Sena Teixeira Santos
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Minas Gerais; UFMG
• Palavras-chave em Português: Artrite reumatóide juvenil; Fatores determinantes; Prognóstico; Cegueira/complicações; Fatores socioeconômicos; Anticorpos antinucleares; Depressão/complicações; Adolescente; Antígeno HLA-B27; Artrite reumatóide juvenil/epidemiologia; Contagem de plaquetas; Adulto; Pré-escolar; Sedimentação sanguínea; Fator reumatóide; Artrite reumatóide juvenil/complicações; Artrite reumatóide juvenil/classificação; Criança
• Link de acesso: http://hdl.handle.net/1843/ECJS-72EP5N

Introduction: Juvenile Rheumatoid Artrhitis (JRA) is the disease caracterized by arthritis which hapens in children under 16 years old and persists for, at least, six weeks, after withdrawing other diseases that manifest with joint envolvment. In the developed world is the comonest rheumatic disease in chidlhood and one of the most frequent cronic disease at this age. There are any epidemiologic studies in Brasil. JRA is not a benin disease. It may extend itself through the adulthood, and causes secondary disablement such low psychosocial adjustment, familiary problems and financial difficulties. We must emphasize that the secondary disablement aren`t directly connected to the severity of the disease. Objectives: To discribe the clinic and demographic profile of the patients with JRA that were followed in the Rheumatology Service of Clinical Hospital of Federal University of Minas Gerais in all of its forms of presentation, evaluate the time between the begining of the simptoms and the diagnosis and describe the incidence of sorologic markers such rheumatoid factor and antinuclear factor, evaluating factors of prognosis.Patiens and methods: Populational descriptive transversal study; It was used standards protocols, that were elaborate just for the study and the Childhood Health Assessement Questionnaire, o CHAQ. The sociodemographic data were compared with data found in IBGE and IPEA sites. Statistical calculations were performed using SPSS for Windows software, version 8.0. Results: We studied 72 patients, 35 female (48,6%) and 37 (51,4%) male. The maximum age at the interview were 348 months and the minimum were 31. Twenty three of the patients used to live in Belo Horizonte and 49 (68,1)% used to live with their father and mother. The minimum familiar income were R$0,00 (0,0 Minimum salary) (MS) and maximum R$4.000,00 (16,67 MS). Thirty seven per cent of the patients were classified as miserable according to the Mundial Health Organization parameters. The age at diagnosis range to 15 months to 205 months. Thirty two of the patiens were oligoarticulares (44,4%), 17 (23,6%) were polyarticular and 23 (31,9%) were systemic. The time of duration of the disease ranged to eight months to 264 months. The diagnosis at the admission were unknown arthritis in twenty three (31,9%) of the patiens, unknown fever in 15 (20,8%) and in 14 (19,4%) it were rheumatic fever. Sixty seven per cent of the patiens live with both father and mother. The average of CHAQ`s disability index was 0,32 and of the disconfort index was 1,05. There were relationship between disability index and the type of onset (p=0,008), the age at the begining of the diseases (p=0,000), the delay of the diagnosis, (p=0,000), the age of the patient at the moment of the interview (p=0,000), the righ erytrocite sedimentation rate at admission (p=0,000), high platelet count at admission (p=0,000), the length of time of the disease (p=0,000), the total familiar income (p=0,000), the use of drugs at the moment at the interview (p=0,018), especially the use of antidrepressants (p=0,032). The disconfort index was positively affected by the age of onset, (p=0,001), the type of onset (p=0,014), the domestic companionship (p=0,0of 0), the use of antidrepressants (p=0,05) and the high platelet count at admission (p=0,009). Conclusions: The majority of the patients (68%) live out of Belo Horizonte, showing that the Rheumatology Hospital das Clínicas da UFMG is a reference Service for all Minas Gerais and even to Bahia state. We may conclude that factors inherent associated to the disease as the type and the age of the child at its onset and the intensity of the inflamatory activity, reflected by the erytrocite sedimentation rate and the high platelet count, factors associated with the treatment: the use of medicines and the delay of the diagnosis and psychosocial factors as familiar income and the familiar structure are determinant for the well being of those children. So, thinking about the prognosis of the pacient with JRA we must consider the child/adolescent as a human being, not as just a patient, considering not just his/her medical needs, but his/her personal needs, and desires. Since the multidisciplinary treatment is mandatory the ideal situation is the structure of the Pediatric Rheumatology Services with differents professionals within the of efficient hospitalar and ambulatorial structures and the regular supplying of medicines by the governamental agencies due to the definitive improvement of the prognosis of those children.