2023 Brazilian Society of Rheumatology guidelines for the treatment of systemic sclerosis.

Autor: Kayser C; Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, Rua dos Otonis 863, 2º andar, Vila Clementino, São Paulo, SP, 04025-002, Brazil. cristiane.kayser@unifesp.br., de Oliveira Delgado SM; Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, Rua dos Otonis 863, 2º andar, Vila Clementino, São Paulo, SP, 04025-002, Brazil.; Rheumatology Division, Hospital Sírio Libanês, Brasília, DF, Brazil., Zimmermann AF; Rheumatology Division, Professor Polydoro Ernani de São Tiago University Hospital, Universidade Federal de Santa Catarina-UFSC, Florianópolis, SC, Brazil., Horimoto AMC; Rheumatology Division, Hospital Regional do Mato Grosso do Sul, Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul-UFMS, Campo Grande, MS, Brazil., Del Rio APT; Rheumatology Division, Universidade Estadual de Campinas-UNICAMP, Campinas, SP, Brazil., de Souza Müller C; Rheumatology Division, Hospital de Clínicas, Universidade Federal do Paraná-UFPR, Curitiba, PR, Brazil., Camargo CZ; Internal Medicine Departament, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista-UNESP, Botucatu, SP, Brazil., Lupo CM; Rheumatology Division, Faculdade de Medicina de São José do Rio Preto-FAMERP, São José do Rio Preto, SP, Brazil., de Moraes DA; Medicine School, Centro Universitário Barão de Mauá-CBM, Ribeirão Preto, SP, Brazil., Do Rosário E Souza EJ; Rheumatology Division, Hospital de Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brazil., Santos FPST; Rheumatology Division, Universidade Federal de Minas Gerais-UFMG, Belo Horizonte, MG, Brazil., Sekiyama JY; Internal Medicine Departament, Universidade Estadual de Maringá-UEM, Maringá, PR, Brazil., Lonzetti LS; Rheumatology Division, Universidade Federal de Ciências da Saúde de Porto Alegre-UFCSPA, Porto Alegre, RS, Brazil., de Oliveira Martins LV; Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo-UNIFESP, Rua dos Otonis 863, 2º andar, Vila Clementino, São Paulo, SP, 04025-002, Brazil., Bezerra MC; Rheumatology Division, Universidade Federal do Ceará-UFC, Fortaleza, CE, Brazil., Bredemeier M; Rheumatology Division, Hospital Nossa Senhora da Conceição, Porto Alegre, RS, Brazil., Oliveira MC; Clinical Immunology Division, Ribeirão Preto Medical School, Universidade de São Paulo-USP, Ribeirão Preto, SP, Brazil., da Fonseca Salgado MC; Rheumatology Division, Universidade Federal do Estado do Rio de Janeiro-UNIRIO, Rio de Janeiro, RJ, Brazil., Miossi R; Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo-USP, São Paulo, SP, Brazil., de Araújo Fontenele SM; Rheumatology Division, Universidade Estadual do Ceará-UECE, Fortaleza, CE, Brazil., Hax V; Rheumatology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul-UFRGS, Porto Alegre, RS, Brazil., Dantas AT; Rheumatology Division, Universidade Federal de Pernambuco-UFPE, Recife, PE, Brazil., Sampaio-Barros PD; Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo-USP, São Paulo, SP, Brazil.
Jazyk: angličtina
Zdroj: Advances in rheumatology (London, England) [Adv Rheumatol] 2024 Jul 10; Vol. 64 (1), pp. 52. Date of Electronic Publication: 2024 Jul 10.
DOI: 10.1186/s42358-024-00392-w
Abstrakt: Background: Systemic sclerosis (SSc) is a rare chronic autoimmune disease with heterogeneous manifestations. In the last decade, several clinical trials have been conducted to evaluate new treatment options for SSc. The purpose of this work is to update the recommendations of the Brazilian Society of Rheumatology in light of the new evidence available for the pharmacological management of SSc.
Methods: A systematic review including randomized clinical trials (RCTs) for predefined questions that were elaborated according to the Patient/Population, Intervention, Comparison, and Outcomes (PICO) strategy was conducted. The rating of the available evidence was performed according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. To become a recommendation, at least 75% agreement of the voting panel was needed.
Results: Six recommendations were elaborated regarding the pharmacological treatment of Raynaud's phenomenon, the treatment (healing) and prevention of digital ulcers, skin involvement, interstitial lung disease (ILD) and gastrointestinal involvement in SSc patients based on results available from RCTs. New drugs, such as rituximab, were included as therapeutic options for skin involvement, and rituximab, tocilizumab and nintedanib were included as therapeutic options for ILD. Recommendations for the pharmacological treatment of scleroderma renal crisis and musculoskeletal involvement were elaborated based on the expert opinion of the voting panel, as no placebo-controlled RCTs were found.
Conclusion: These guidelines updated and incorporated new treatment options for the management of SSc based on evidence from the literature and expert opinion regarding SSc, providing support for decision-making in clinical practice.
(© 2024. The Author(s).)
Databáze: MEDLINE
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