Lúpus: novos critérios de diagnóstico

 

 

Pergunta clínica: Qual deverá ser a abordagem diagnóstica de doentes com suspeita de Lupus Eritematoso Sistémico?

Enquadramento: A Liga Europeia contra o Lupus e o Colégio Americano de Reumatologia reúnem-se frequentemente para actualização de normas para o diagnóstico e seguimento de uma grande diversidade de problemas reumatológicos. Desde 1982 que foram nomeadas várias abordagens para avaliação de doentes com suspeita de Lupus Eritematoso Sistémico. Cada atualização reflete o desenvolvimento da compreensão da doença e novos ensaios clínicos.

Desenho do estudo: Estes novos critérios de classificação foram desenvolvidos através de um processo que incluiu várias abordagens, desde revisões sistemáticas; método Delphi; revisões por especialistas; aplicação dos critérios em doentes com Lúpus Eritematoso Sistémico precoce ou condições que se assemelham a Lúpus Eritematoso Sistémico; aperfeiçoamento e ponderação dos critérios em doentes com Lúpus Eritematoso Sistémico confirmado; e incorporando opinião dos doentes com Lúpus Eritematoso Sistémico.

Resultados: A recomendação final consiste em realizar em primeiro lugar o doseamento do Anticorpo Antinuclear; se existir titulação de pelo menos 1:80, aplicam-se os critérios adicionais e a sua ponderação. Se for superior a 10 ou mais pontos, é provável que o doente tenha Lúpus Eritematoso Sistémico. Os critérios adicionais e sua ponderação assentam em vários domínios e são os seguintes: febre (2), leucopenia (3), trombocitopenia (4), hemólise autoimune (4), delírio (2), psicose (2), convulsão (5), alopecia não cicatrizada (2), aftas (2), lúpus cutâneo subagudo ou lúpus discoide (4), lúpus cutâneo agudo (6), derrame pleural ou pericárdico (5), pericardite aguda (6), envolvimento articular (6), proteinuria >0.5g/24h (4), biopsia renal classe II ou nefrite lúpica tipo V (8), biópsia renal classe III ou nefrite lúpica tipo IV (10), anticorpo anti-cardiolipina OU anticorpo anti beta 2GP1 OU anticoagulante lúpico (2), C3 baixo OU C4 baixo (3), C3 baixo E C4 baixo (4), anticorpo anti-dsDNA OU anticorpo anti-smith (6). Para  criar uma estrutura de apoio à telemedicina, estabeleceram-se critérios fotográficos tais como alopécia, afta ou manifestações cutâneas. Comparativamente com os critérios de 1997, estes novos critérios apresentam maior sensibilidade (96.1% vs 82.8%) e a mesma especificidade (93.4%). Comparativamente aos critérios de 2012, a sensibilidade foi semelhante (96.1% vs 96.7%) mas apresentam maior especificidade (93.4% vs 83.7%).

Comentário: Estes novos critérios de classificação do Lúpus Eritematoso Sistémico para além de serem mais sensíveis e específicos, permitem um diagnóstico mais preciso e adequado de Lúpus Eritematoso Sistémico. De acordo com este documento se o doseamento de Anticorpo Antinuclear for negativo, está excluído o diagnostico de Lúpus Eritematoso Sistémico, o que poderá contribuir para uma maior clareza na abordagem do doente evitando uma cascata de novos exames.

Artigo original: Arthritis Rheumatol

Por Marta Fraga, USF Araceti

 

22 Comentários. Deixe novo

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