Normas Clínicas/Clinical Guidelines
Recomendações para o diagnóstico e tratamento das tuberculoses latente e activa nas doenças inflamatórias articulares candidatas a terapêutica com fármacos inibidores do factor de necrose tumoral alfa. Revisão de Março de 2008*
Recommendations for the diagnosis and treatment of latent and active tuberculosis in inflammatory joint diseases candidates for therapy with tumor necrosis factor alpha inhibitors – March 2008 update*
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Revisão de Março de 2008<a class="elsevierStyleCrossRef" href="#fn0005">*</a>" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "271" "paginaFinal" => "283" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "João Eurico Fonseca, Helena Lucas, Helena Canhão, Raquel Duarte, Maria José Santos, Miguel Villar, Augusto Faustino, Elena Raymundo" "autores" => array:8 [ 0 => array:3 [ "nombre" => "João Eurico" "apellidos" => "Fonseca" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "af0005" ] ] ] 1 => array:3 [ "nombre" => "Helena" "apellidos" => "Lucas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "af0010" ] ] ] 2 => array:3 [ "nombre" => "Helena" "apellidos" => "Canhão" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "af0005" ] ] ] 3 => array:3 [ "nombre" => "Raquel" "apellidos" => "Duarte" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "af0010" ] ] ] 4 => array:3 [ "nombre" => "Maria José" "apellidos" => "Santos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "af0005" ] ] ] 5 => array:3 [ "nombre" => "Miguel" "apellidos" => "Villar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "af0010" ] ] ] 6 => array:3 [ "nombre" => "Augusto" "apellidos" => "Faustino" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "af0005" ] ] ] 7 => array:3 [ "nombre" => "Elena" "apellidos" => "Raymundo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">2</span>" "identificador" => "af0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Rheumatoid Arthritis Study Group (Grupo de Estudos de Artrite Reumatóide-GEAR) of the Portuguese Society of Rheumatology (Sociedade Portuguesa de Reumatologia – SPR)" "etiqueta" => "1" "identificador" => "af0005" ] 1 => array:3 [ "entidad" => "Tuberculosis Committee of the Portuguese Society of Pulmonology (Sociedade Portuguesa de Pneumologia – SPP)" "etiqueta" => "2" "identificador" => "af0010" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Recommendations for the diagnosis and treatment of latent and active tuberculosis in inflammatory joint diseases candidates for therapy with tumor necrosis factor alpha inhibitors – March 2008 update<a class="elsevierStyleCrossRef" href="#fn0005">*</a>" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2008-02-21" "fechaAceptado" => "2008-02-22" "PalabrasClave" => array:2 [ "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec570409" "palabras" => array:5 [ 0 => "Guidelines" 1 => "Sociedade Portuguesa de Reumatologia" 2 => "Sociedade Portuguesa de Pneumologia" 3 => "tuberculose" 4 => "anti-TNFα" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec570410" "palabras" => array:5 [ 0 => "Guidelines" 1 => "Portuguese Society of Rheumatology" 2 => "Portuguese Society of Pulmonology" 3 => "Tuberculosis" 4 => "Anti-TNFα drugs" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">A Sociedade Portuguesa de Reumatologia e a Sociedade Portuguesa de Pneumologia actualizaram as recomendações para o diagnóstico e a terapêutica das tuberculoses latente (TL) e activa (TD) em doentes com doenças inflamatórias articulares (DIA), candidatos a tratamento com antagonistas do factor de necrose tumoral alfa (TNFα). Com o objectivo de reduzir o risco de reactivação da tuberculose (TB) ou nova infecção, recomenda-se o rastreio de TD e TL tão precocemente quanto possível, preferencialmente no momento do diagnóstico da DIA, e repetir a avaliação do doente antes de iníciar terapêutica anti-TNFα. O tratamento da TD e TL deve ser sempre supervisionado por um especialista em TB. Quando houver indicação para terapêutica de TB, esta deverá ser cumprida integralmente antes de se iniciar o anti-TNFα. No caso da actividade da DIA o exigir, o anti-TNFα poderá ser iniciado após dois meses de terapêutica antibacilar, no caso de TD, ou após um mês, no caso de TL. Todos os doentes devem realizar radiografia do tórax. Alterações compatíveis com complexo de Gohn devem ser tratadas como TL. Lesões residuais obrigam a excluir TB activa. Se se suspeitar de lesões em actividade, o diagnóstico de TD deve ser excluido e o tratamento adequado instituído.</p><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">A prova tuberculínica (PT), com 2 unidades de tuberculina RT23, deverá ser efectuada em todos os doentes. Se a induração for <<span class="elsevierStyleHsp" style=""></span>5 mm, a prova deve ser repetida dentro de 1 a 2 semanas no antebraço oposto, e considerada negativa apenas se o segundo resultado for igualmente <<span class="elsevierStyleHsp" style=""></span>5 mm. As PT positivas obrigam a tratamento de TL, excepto se o doente tiver sido previamente tratado de forma adequada. Se a PT é realizada apenas em fase de imunodepressão, mesmo que seja negativa, deve ser equacionado o tratamento de TL antes de iniciar terapêutica anti-TNFα, após ponderar a relação risco/benefício.</p><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2007; XIV (2): 271-283</span></p></span>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">The Portuguese Society of Rheumatology and the Portuguese Society of Pulmonology have updated the guidelines for the diagnosis and treatment of latent tuberculosis infection (LTBI) and active tuberculosis (ATB) in patients with inflammatory joint diseases (IJD) that are candidates to therapy with tumour necrosis factor alpha (TNFα) antagonists. In order to reduce the risk of tuberculosis (TB) reactivation and the incidence of new infections, TB screening is recommended to be done as soon as possible, ideally at the moment of IJD diagnosis, and patient assessment repeated before starting anti-TNFα therapy. Treatment for ATB and LTBI must be done under the care of a TB specialist. When TB treatment is indicated, it should be completed prior to starting anti-TNFα therapy. If the IJD activity justifies the need for immediate treatment, anti-TNFα therapy can be started two months after antituberculous therapy has been initiated, in the case of ATB, and one month after in the case of LTBI. Chest X-ray is mandatory for all patients. If Gohn’s complex is present, the patient should be treated for LTBI; healed lesions require the exclusion of ATB. In cases of suspected active lesions, ATB should be excluded/confirmed and adequate therapy initiated.</p><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall">Tuberculin skin test, with two units of RT23, should be performed in all patients. If the induration is <<span class="elsevierStyleHsp" style=""></span>5 mm, the test should be repeated within 1 to 2 weeks, on the opposite forearm, and will be considered negative only if the result is again <<span class="elsevierStyleHsp" style=""></span>5 mm. Positive TST implicates LTBI treatment, unless previous proper treatment was provided. If TST is performed in immunossuppressed IJD patients, LTBI treatment should be offered to the patient before starting anti-TNF-α therapy, even in the presence of a negative test, after risk / benefit assessment.</p><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2007; XIV (2): 271-283</span></p></span>" ] ] "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="np0005">O presente artigo foi publicado simultaneamente <span class="elsevierStyleItalic">in Acta Reumatol Port 2008;33:77-85 This article has been copublished in Acta Reumatol Port 2008; 33: 77-85</span></p>" "identificador" => "fn0005" ] ] "lecturaRecomendada" => array:1 [ 0 => array:3 [ "vista" => "all" "titulo" => "<span class="elsevierStyleSectionTitle" id="st0025">Bibliography</span>" "seccion" => array:1 [ 0 => array:2 [ "vista" => "all" "bibliografiaReferencia" => array:41 [ 0 => array:3 [ "identificador" => "bb0005" "etiqueta" => "1." 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Article information
ISSN: 08732159Original language: Portuguese
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| 2020 October | 21 | 8 | 29 |
| 2020 September | 61 | 27 | 88 |
| 2020 August | 56 | 20 | 76 |
| 2020 July | 92 | 16 | 108 |
| 2020 June | 65 | 19 | 84 |
| 2020 May | 68 | 17 | 85 |
| 2020 April | 76 | 9 | 85 |
| 2020 March | 50 | 16 | 66 |
| 2020 February | 49 | 25 | 74 |
| 2020 January | 59 | 23 | 82 |
| 2019 December | 53 | 17 | 70 |
| 2019 November | 74 | 16 | 90 |
| 2019 October | 53 | 12 | 65 |
| 2019 September | 54 | 23 | 77 |
| 2019 August | 72 | 23 | 95 |
| 2019 July | 46 | 13 | 59 |
| 2019 June | 39 | 9 | 48 |
| 2019 May | 43 | 25 | 68 |
| 2019 April | 37 | 21 | 58 |
| 2019 March | 64 | 16 | 80 |
| 2019 February | 87 | 15 | 102 |
| 2019 January | 67 | 18 | 85 |
| 2018 December | 42 | 12 | 54 |
| 2018 November | 6 | 3 | 9 |
| 2018 October | 3 | 0 | 3 |
| 2018 September | 13 | 4 | 17 |
| 2018 August | 37 | 22 | 59 |
| 2018 July | 28 | 25 | 53 |
| 2018 June | 42 | 17 | 59 |
| 2018 May | 45 | 17 | 62 |
| 2018 April | 35 | 34 | 69 |
| 2018 March | 42 | 27 | 69 |
| 2018 February | 15 | 14 | 29 |
| 2018 January | 37 | 10 | 47 |
| 2017 December | 26 | 12 | 38 |
| 2017 November | 34 | 13 | 47 |
| 2017 October | 26 | 17 | 43 |
| 2017 September | 18 | 15 | 33 |
| 2017 August | 25 | 14 | 39 |
| 2017 July | 12 | 5 | 17 |
| 2017 June | 16 | 10 | 26 |
| 2017 May | 31 | 6 | 37 |
| 2017 April | 8 | 3 | 11 |
| 2017 March | 16 | 4 | 20 |
| 2017 February | 12 | 1 | 13 |
| 2017 January | 10 | 4 | 14 |
| 2016 December | 8 | 7 | 15 |
| 2016 November | 7 | 2 | 9 |
| 2016 October | 9 | 12 | 21 |
| 2016 September | 6 | 2 | 8 |
| 2016 August | 4 | 1 | 5 |
| 2016 July | 7 | 5 | 12 |
| 2016 May | 7 | 8 | 15 |
| 2016 April | 1 | 1 | 2 |
| 2016 March | 1 | 4 | 5 |
| 2016 February | 5 | 9 | 14 |
| 2016 January | 8 | 9 | 17 |
| 2015 December | 6 | 6 | 12 |
| 2015 November | 3 | 2 | 5 |
| 2015 October | 3 | 3 | 6 |
Show all
