Insights from Portuguese Nephrologists and Rheumatologists Concerning the Treatment of ANCA Vasculitis

Inês Ferreira; Ana Águeda; Carolina Belino; Bruno Schau; João Rovisco; Carina Ferreira

doi:10.20344/amp.21635

Autores

Inês Ferreira Department of Medicine. Faculdade de Medicina. Universidade do Porto. Porto; Departament of Nephrology. Hospital de São João. Unidade Local de Saúde de São João. Porto.
Ana Águeda Department of Rheumatology. Hospital Pêro da Covilhã. Unidade Local de Saúde da Cova da Beira. Covilhã.
Carolina Belino Department of Rheumatology. Hospital Pêro da Covilhã. Unidade Local de Saúde da Cova da Beira. Covilhã.
Bruno Schau CSL Vifor. Lisboa.
João Rovisco Department of Rheumatology. Hospitais da Universidade de Coimbra. Unidade Local de Saúde de Coimbra. Coimbra.
Carina Ferreira Department of Nephrology. Hospital Curry Cabral. Unidade Local de Saúde de São José. Lisbon; NOVA Medical School. Universidade NOVA de Lisboa. Lisbon.

DOI:

https://doi.org/10.20344/amp.21635

Palavras-chave:

Nefrologistas, Padrões de Prática Médica, Reumatologistas, Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos

Resumo

Introdução: As vasculites associadas a anticorpos citoplasmáticos antineutrófilos (AAV) engloba a granulomatose com poliangiite, a poliangiite microscópica e a granulomatose eosinofílica com poliangiite. Estas doenças raras caracterizam-se por uma resposta imunológica exacerbada nos vasos sanguíneos, levando a inflamação, lesão vascular, isquemia e necrose dos tecidos e órgãos afetados. Apesar de existirem recomendações europeias para o tratamento da AAV, a sua implementação em Portugal permanece desconhecida.
Métodos: Para abordar esta lacuna, foi realizado um painel online do tipo Delphi envolvendo 55 nefrologistas e reumatologistas portugueses, representando as principais especialidades envolvidas na gestão da AAV. O principal objetivo foi avaliar o nível de consenso em relação ao tratamento da AAV em Portugal e aplicação das recomendações europeias na prática clínica diária. Os especialistas avaliaram 29 afirmações formuladas por um grupo de peritos portugueses com vasta experiência em AAV, abordando aspetos-chave da gestão da AAV, classificadas numa escala Likert de 4 pontos. O consenso foi definido como > 70% das respostas a concordar totalmente ou a discordar totalmente com uma declaração, enquanto o nível de maioria exigia > 70% de concordância ou discordância.
Resultados: Após uma ronda, nenhuma declaração alcançou consenso de forma global, e oito das 29 declarações não atingiram uma maioria qualificada. Contudo, este estudo demonstra um elevado nível de concordância em cada especialidade médica, devido às características distintas das populações de doentes tratadas por cada especialidade. Embora os resultados sugiram uma adesão parcial às recomendações europeias, também destacam a necessidade de padronizar as práticas clínicas de tratamento da AAV em Portugal.
Conclusão: Este estudo sublinha a importância de alinhar as práticas nacionais com as recomendações europeias estabelecidas para garantir os melhores resultados para os doentes com AAV.

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