葡萄牙关于系统性硬化症和其他结缔组织疾病患者雷诺现象和数字溃疡治疗的建议。

IF 1.4 4区 医学 Q3 RHEUMATOLOGY
ARP Rheumatology Pub Date : 2024-04-01
Tânia Santiago, Ana Catarina Duarte, Alexandre Sepriano, Alice Castro, Bruno Rosa, Catarina Resende, Daniela Oliveira, Eduardo Dourado, Emanuel Costa, Filipe Cunha-Santos, Georgina Terroso, Gonçalo Boleto, Ivone Silva, Lurdes Barbosa, Joana Silva, Joana Sousa Neves, Maria João Salvador, Maria João Gonçalves, Miguel Gomes Guerra, Raquel Miriam Ferreira, Rúben Duarte-Fernandes, Sofia Barreira, Vítor Silvestre Teixeira, Ana Lúcia Tomás, Vasco Romão, Ana Cordeiro
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引用次数: 0

摘要

目的为系统性硬化症和其他免疫介导结缔组织病(CTD)患者雷诺现象(RP)和数字溃疡(DU)的非药物和药物治疗制定循证建议:成立了一个由 21 名风湿病专家、两名外科医生(血管外科医生和整形外科医生)、两名护士和一名患者代表组成的工作组。在进行了系统的文献回顾以提供建议信息后,在两次会议(一次在线会议和一次现场会议)上制定并讨论了声明。确定了证据等级、建议等级(GoR)和同意等级(LoA):结果:制定了五项总体原则和 13 项建议。总体原则和建议的平均±标准差 (SD) LoA 为 7.8±2.1 到 9.8±0.4。简而言之,CTD 患者的 RP 和 DU 管理应由多学科团队协调,并与患者共同决策。硝苯地平应作为 RP 和/或 DU 的一线治疗药物。西地那非、他达拉非和/或伊洛前列素静脉注射是严重和/或难治性 RP 和/或 DU 患者的二线选择。西地那非、他达拉非和/或伊洛前列素静脉滴注应作为治疗和预防(也包括波生坦)DU 的处方。对于RP和/或DUs患者,非药物干预措施可作为附加治疗,但支持其使用的科学证据在质量和数量上都很有限:这些建议将为风湿免疫科医生、专科护士、其他医疗保健专业人员和患者提供全面、个性化的 RP 和 DUs 管理方法。针对尚未满足的需求,特别是非药物干预方面的需求,制定了一项研究议程。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Portuguese Recommendations for the management of Raynaud's phenomenon and digital ulcers in systemic sclerosis and other connective tissue diseases.

Objective: To develop evidence-based recommendations for the non-pharmacological and pharmacological management of Raynaud's phenomenon (RP) and digital ulcers (DUs) in patients with systemic sclerosis and other immune-mediated connective tissue diseases (CTDs).

Methods: A task force comprising 21 rheumatologists, two surgeons (vascular and plastic), two nurses, and one patient representative was established. Following a systematic literature review performed to inform the recommendations, statements were formulated and discussed during two meetings (one online and one in-person). Levels of evidence, grades of recommendation (GoR), and level of agreement (LoA) were determined.

Results: Five overarching principles and 13 recommendations were developed. GoR ranged from A to D. The mean ± standard difference (SD) LoA with the overarching principles and recommendations ranged from 7.8±2.1 to 9.8±0.4. Briefly, the management of RP and DUs in patients with CTDs should be coordinated by a multidisciplinary team and based on shared decisions with patients. Nifedipine should be used as first-line therapy for RP and/or DUs. Sildenafil, tadalafil, and/or iloprost IV are second-line options for severe and/or refractory patients with RP and/or DUs. Sildenafil, tadalafil and/or Iloprost IV, should be prescribed for healing and prevention (also including bosentan) of DUs. In patients with RP and/or DUs, non-pharmacological interventions might be considered as add-ons, but there is limited quality and quantity of scientific evidence supporting their use.

Conclusions: These recommendations will inform rheumatologists, specialist nurses, other healthcare professionals, and patients about a comprehensive and personalized management of RP and DUs. A research agenda was developed to address unmet needs, particularly for non-pharmacologic interventions.

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