Guidelines

Início/Guidelines

Artrite Idiopática Juvenil

Versão pdf Objective: To update the Portuguese recommendations in order to assist the rational and safe prescribing of biological therapies in children and adolescents with Juvenile Idiopathic Arthritis (JIA) as more evidence and experience with these drugs are available. Methods: The recommendations were formulated by Rheumatologists and Pediatricians, with experience in Pediatric Rheumatology, based on literature evidence and consensus opinion. The evidence was sought through a MEDLINE search. The retrieved results were discussed and a set of recommendations proposed. All propositions were extensively debated and the final recommendations formulated. Results: A consensus was achieved regarding the eligibility, response criteria, maintenance of biologic therapy, and procedures in case of non-response. Also, specific recommendations concerning safety procedures before [...]

2019-12-12T13:38:15+00:0012 de Dezembro de 2019|

Artrite Psoriática

Objective: To develop recommendations for the treatment of psoriatic arthritis (PsA) with biological therapies, endorsed by the Portuguese Society of Rheumatology. Methods: These treatment recommendations were formulated by Portuguese rheumatologists based on literature evidence and consensus opinion. A draft of the recommendations was first circulated to all Portuguese rheumatologists and their suggestions were incorporated in the draft. At a national meeting the recommendations were discussed and all attending rheumatologists voted on the level of agreement for each recommendation. A second draft was again circulated before publication. Results: A consensus was achieved regarding the initiation, assessment of response and switching biological therapies in patients with PsA. Specific recommendations were developed for several disease domains: peripheral arthritis, axial disease, [...]

2019-12-12T13:39:04+00:0011 de Dezembro de 2019|

Artrite Reumatóide

Os autores apresentam a actualização dos Consensos sobre a utilização de terapêuticas biológicas na artrite reumatóide (AR), elaborados por um grupo de trabalho da Sociedade Portuguesa de Reumatologia (SPR). Nestas normas nacionais são discutidos os critérios para início e manutenção de terapêutica biológica, contra-indicações para a sua utilização e actuação se o doente for não respondedor. Para início de terapêutica biológica (com um antagonista do factor de necrose tumoral, abatacept ou tocilizumab) os doentes com AR devem ter um disease activity score 28 (DAS 28) igual ou superior a 3,2, após pelo menos 3 meses de tratamento com metotrexato (MTX) na dose mínima de 20mg/semana, ou, na impossibilidade de tratamento com MTX nesta dose, após 3 meses [...]

2019-12-12T13:39:36+00:0010 de Dezembro de 2019|

Espondilite Anquilosante

Objective: To develop recommendations for the treatment of axial spondyloarthritis with biological therapies, endorsed by the Portuguese Society of Rheumatology. Methods: These treatment recommendations were formulated by Portuguese rheumatologists based on literature evidence and consensus opinion. A draft of the recommendations and supporting evidence was first circulated to all Portuguese rheumatologists and their suggestions were incorporated in the draft. Secondly, at a national meeting the recommendations were presented, discussed and revised. Finally, the document resulting from this meeting was again circulated to all Portuguese rheumatologists, who anonymously voted online on the level of agreement with the recommendations. Results: A consensus was achieved regarding the initiation, assessment of response and switching biological therapies in patients with axial spondyloarthritis. [...]

2019-12-12T13:40:19+00:009 de Dezembro de 2019|

Osteoporose

Background: Advances in osteoporosis(OP) case definition, treatment options, optimal therapy duration and pharmacoeconomic evidence in the national context motivated tte Portuguese Society of Rheumatology (SPR) to update the Portuguese recommendations for the diagnosis and management of osteoporosis published in 2007. Methods: SPR bone diseases’ working group organized meetings involving 55 participants (rheumatologists, rheumatology fellows and one OP specialist nurse) to debate and develop the document. First, the working group selected 11 pertinent clinical questions for the diagnosis and management of osteoporosis in standard clinical practice. Then, each question was investigated through literature review and draft recommendations were built through consensus. When insufficient evidence was available, recommendations were based on experts’ opinion and on good clinical practice. At [...]

2019-12-12T13:42:36+00:007 de Dezembro de 2019|

Tuberculose

Chronic immunosuppression is a known risk factor for tuberculosis. Our aim was to reach a consensus on screening and prevention of tuberculosis in patients with immune mediated inflammatory diseases candidates to biologic therapy. Methods: Critical appraisal of the literature and expert opinion on immunosuppressive therapies and risk of tuberculosis. Results and Conclusion: The currently recommen ded method for screening is the tuberculin skin test and the interferon gamma assay, after exclusion of active tuberculosis. Positively screened patients should be treated for latent tuberculosis infection. Patients may start biological therapy after 1 to 2 months, as long as they are strictly adhering to and tolerating their preventive regimen. Versão pdf Versão pdf Versão pdf [...]

2019-12-12T13:42:41+00:006 de Dezembro de 2019|

Biossimilares

Biotechnological drugs have become a fundamental resource for the treatment of rheumatic patients. Patent expiry of some of these drugs created the opportunity for biopharmaceutical manufacturers to develop biosimilar drugs intended to be as efficacious as the originator product but with a lower cost to healthcare systems. Due to the complex manufacturing process and highly intricate structure of biologicals, a biosimilar can never be an exact copy of its reference product. Consequently, regulatory authorities issued strict preclinical and clinical guidelines to ensure safety and efficacy equivalence and, in September 2013, the biosimilar of infliximab was the first biosimilar monoclonal antibody to be authorized for use in the European Union. The current document is a position statement of [...]

2019-12-12T13:43:06+00:005 de Dezembro de 2019|

Metotrexato

Background: Methotrexate (MTX) is the first-line drug in the treatment of rheumatoid arthritis (RA) and the most commonly prescribed disease modifying antirheumatic drug. Moreover, it is also used as an adjuvant drug in patients under biologic therapies, enhancing the efficacy of biologic agents. Objectives: To review the literature and update the Portuguese recommendations for the use of MTX in rheumatic diseases first published in 2009. Methods: The first Portuguese guidelines for the use of MTX in rheumatic diseases were published in 2009 and were integrated in the multinational 3E Initiative (Evidence Expertise Exchange) project. The Portuguese rheumatologists based on literature evidence and consensus opinion formulated 13 recommendations. At a national meeting, the recommendations included in this document [...]

2019-12-12T13:43:53+00:004 de Dezembro de 2019|

Gota

Objective: To develop Portuguese evidence-based recommendations for the Diagnosis and Management of Gout. Methods: As part of the 3e Initiative (Evidence, Expertise and Exchange), a panel of 78 international rheumatologists developed 10 relevant clinical questions which were investigated with systematic literature reviews. MEDLINE, EMBASE, Cochrane CENTRAL and abstracts from 2010-2011 EULAR and ACR meetings were searched. Based on the evidence found in the published literature, rheumatologists from 14 countries developed national recommendations that were merged and voted into multinational recommendations. We present the Portuguese recommendations for the Diagnosis and Management of Gout which were formulated and voted by Delphi method in April 2012, in Lisbon. The level of agreement and potential impact in clinical practice was also [...]

2019-12-12T13:44:18+00:003 de Dezembro de 2019|
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