Eficácia do pamidronato na melhora da dor e da qualidade de vida em pacientes com displasia fibrosa óssea
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2018-11-22
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Pechutti, Monise da Silva
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Universidade Estadual Paulista (Unesp)
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Introdução: A displasia fibrosa óssea (DFO) é uma doença rara, de origem genética somática, não hereditária, caracterizada por formação de tumores ósseos, resultando em dor óssea, deformidade e fraturas. Não há tratamento curativo e a cirurgia tem como finalidade a correção de fraturas e descompressão nervosa. A dor, principal sintoma desta doença, é fator limitante para as atividades diárias e prejudica a qualidade de vida. Para o alívio da dor óssea, os bisfosfonatos desempenham fundamental importância. Até o momento, não há consenso sobre o bisfosfonato mais adequado, o tempo ou o número ideal de ciclos de aplicação da medicação. Vários marcadores bioquímicos vêm sendo propostos no seguimento dos pacientes, ainda também sem definição sobre o mais adequado. A adequada quantificação de parâmetros relacionados à resposta terapêutica, particularmente da dor e da qualidade de vida, podem propiciar a monitorização objetiva e desempenhar papel norteador na abordagem destes pacientes. Objetivos: Avaliar a eficácia do pamidronato em pacientes com DFO, na melhora da dor óssea e da qualidade de vida. Casuística e métodos: Foram convidados a participar do estudo todos os pacientes portadores de DFO atendidos nos Ambulatórios de Endocrinologia, Ortopedia e Pediatria do Hospital das Clínicas da Faculdade de Medicina da Universidade Estadual Paulista “Júlio de Mesquita Filho” Unesp. Este estudo observacional, avaliou pacientes com DFO de forma prospectiva, por meio de coleta de dados dos prontuários médicos e através de aplicação de questionários, com foco no relato da presença de dor, qualidade de vida, alterações cintilográficas ósseas e resultados bioquímicos. Os instrumentos utilizados, aplicados em dois momentos com cerca de um ano de intervalo, foram a Escala Numérica Visual e Verbal para Avaliação da Dor, o Mapa das Áreas Corporais [MAC; 24 áreas corporais (AC) consideradas] e o Inventário Breve da Dor, para a avaliação da dor. Para avaliação da qualidade de vida, foi utilizado o Medical Outcomes Study 36 Short-Form Health Survey. As AC dolorosas foram relacionadas às AC acometidas pela DFO, de acordo com a captação em cintilografias ósseas. Resultados: A amostra constituiu-se de 11 pacientes, sendo a maioria mulheres (n=8; 72,7%), com raça referida branca (n=8; 72,7%) e ensino fundamental (n=6; 54,5%) O início dos sintomas dos pacientes foi, em média, aos 16,8 anos (± DP de 13,7 anos). As queixas que motivaram a primeira consulta médica foram a dor óssea isolada (n=4; 36,4%) e as fraturas isoladas (n=3; 27,3%). Sete pacientes Resumo 3 apresentavam mais de um osso acometido (63,6%), com cinco casos (45,6%) apresentando dois a quatro ossos displásicos, enquanto a forma crânio-facial ocorreu em três indivíduos (27,3%). No início da coleta de dados, seis pacientes (54,5%) já faziam tratamento clínico com pamidronato, enquanto que dois iniciaram o tratamento após a primeira coleta de dados e três não receberam terapia específica. Considerando-se o MAC, todos os pacientes apresentavam pelo menos uma AC dolorosa acometida pela DFO, de acordo com a cintilografia. O número médio (± DP) de AC acometidas foi de 6,54 (± 6,97), correspondendo a 27,3% do total de 24 AC consideradas. Todos os pacientes apresentavam dor em ao menos uma AC acometida pela doença. O número médio (± DP) de locais dolorosos e com acometimento cintilográfico foi de 2,82 (±1,72), correspondendo a 11,8% das AC totais e a 43,1% das AC acometidas, com nota média de dor de 5,89 (± 2,42). Seis pacientes (54,5%) apresentavam dor em locais sadios à cintilografia. O número médio (± DP) de locais dolorosos sem acometimento cintilográfico foi de 2,72 (± 3,66), correspondendo a 11,3% das AC totais e a 15,6% das AC sadias, com nota média de dor de 2,15 (± 2,74). A nota da dor foi superior nas AC acometidas cintilograficamente do que nas sadias (p=.0,0092). Quando comparados, separadamente, os pacientes que receberam tratamento com os não tratados, ao longo de um ano de seguimento, observou-se que, nos tratados, houve redução na interferência da dor para a realização de atividades cotidianas (gerais), na habilidade de caminhar e na qualidade do sono (p< 0,05). Comparando-se os pacientes tratados com pamidronato com os não tratados, pelos dados agrupados nos dois anos de questionários, quanto ao IBD, notou-se que maiores percentuais de pacientes tratados faziam uso de analgésicos que os não tratados (p= 0,00607), não havendo diferença significante entre os grupos quando subdivididos quanto ao tipo de analgésicos. Nenhum dos pacientes não tratados fazia uso de analgésicos opioides. Conclusões: Neste grupo de pacientes, o uso de pamidronato foi associado à redução da interferência da dor em aspectos de vida diários, embora não tenha influenciado na qualidade de vida.
Introduction: Fibrous Dysplasia (FD) is a rare disease of genetic origin, autosomal, not hereditary, characterized by the formation of bone tumors, resulting in bone pain, deformity and fracture. There is no curative treatment, and the only purpose of surgery is to correct fractures and nerve decompression. Pain is the main symptom, and limit daily activities impairing quality of life. For the relief of bone pain, bisphosphonates play a fundamental role. Until this moment, there is no consensus on which is the most adequate bisphosphonate to be used, the ideal timing of the application and the number of optimal medication application cycles. Several biochemical markers have been proposed in the follow-up of these patients, but yet there is no definition of the most appropriate. Proper quantification of parameters that evaluate therapeutics response, in particular pain and quality of life, can propitiate objective monitoring and play a guiding paper into approach these patients. Objectives: To evaluate the effect of using bisphosphonates in patients with FD, with perception of the improvement in relieving bone pain and quality of life. Methods: All the patients with FD attended in the Ambulatories of Endocrinology, Orthopedics and Pediatrics of the Hospital of the Medical School of Universidade Estadual Paulista “Júlio de Mesquita Filho” (Unesp) were invited to participate the research. This observational study, evaluate FD patients in a retrospective form, gathering medical records data, and in a prospective form through the questionnaires application and newly medical records clustering, focusing pain report, quality of life, bone scintigraphy and laboratory results. Research instruments were applied in tow moments, in one year interval, the Verbal and Visual Numeric Scale for rating pain, the Margolis drawing rating system [MDRS; 24 body areas (BA) considered], and Brief Pain Inventory (BPI), for evaluating pain. For quality of life appreciation, were used the o Medical Outcomes Study 36 Short- Form Health Survey. The painful BA were related to dysplastic BA (affected BA), according the bone scintigraphy. Results: The sample was composed by 11 patients, being most women (n=8; 72,7%), main racial classification referred white (n=8; 72,7%) and elementary/middle school (n=6; 54,5%). The symptoms outset average 16,8 years (±standard deviation of 13,7 years). Demands at first doctor's appointment was Abstract 6 isolated bone pain (n=4; 36,4%) and isolated bone fracture (n=3; 27,3%). Seven patients had more than one affected bone (63,6%), with five cases (45,6%) presenting two to four dysplastic bone, whilst cranium-facial form happen in three (27,3%). At the priming data gathering, six patients (54,5%) already received pamidronate, while tow initiate treatment behind gathering and three did not received specific treatment. Considering the MDRS, all patients present at least one painful dysplastic BA, according to scintigraphy. The average (± standard deviation) affected BA was 6,54 (± 6,97), corresponding 27,3% of 24 total considered BA. All patients had at least one painful affected BA. The average (± standard deviation) painful areas that was scintigraphy affected was 2,82 (±1,72), corresponding 11,8% of total BA and 43,1% of affected BA, with average rating pain 5,89 (± 2,42). Six patients (54,5%) had related pain in healthy spots according to scintigraphy. The average (± standard deviation) pain healthy spots was 2,72 (± 3,66) corresponding 11,3% of total BA and 15,6% of healthy BA, with rating pain 2,15 (± 2,74). Rating pain was higher in scintigraphy affected BA (p=0,0092). When isolated compared, patients who received treatment whit non treated, one year long, it was observed that, treated ones reduced pain interference to carry out quoted activities (general), into walking ability , and sleep quality (p <0,005). Comparing patients who received treatment whit non treated by grouped data collected in two years of applied questionnaires, about BPI, it was noted that higher percentage of treated patients had to make use of analgesic drugs than non-treated (p=0,00607), there was no difference between groups when subdivided about the analgesic types. Anyone of non-treated patients was in opioid use. Conclusion: In this group of patients, use of pamidronate was associated at the reduction on pain interference at daily aspects, although, it was not observed influence on quality of life.
Introduction: Fibrous Dysplasia (FD) is a rare disease of genetic origin, autosomal, not hereditary, characterized by the formation of bone tumors, resulting in bone pain, deformity and fracture. There is no curative treatment, and the only purpose of surgery is to correct fractures and nerve decompression. Pain is the main symptom, and limit daily activities impairing quality of life. For the relief of bone pain, bisphosphonates play a fundamental role. Until this moment, there is no consensus on which is the most adequate bisphosphonate to be used, the ideal timing of the application and the number of optimal medication application cycles. Several biochemical markers have been proposed in the follow-up of these patients, but yet there is no definition of the most appropriate. Proper quantification of parameters that evaluate therapeutics response, in particular pain and quality of life, can propitiate objective monitoring and play a guiding paper into approach these patients. Objectives: To evaluate the effect of using bisphosphonates in patients with FD, with perception of the improvement in relieving bone pain and quality of life. Methods: All the patients with FD attended in the Ambulatories of Endocrinology, Orthopedics and Pediatrics of the Hospital of the Medical School of Universidade Estadual Paulista “Júlio de Mesquita Filho” (Unesp) were invited to participate the research. This observational study, evaluate FD patients in a retrospective form, gathering medical records data, and in a prospective form through the questionnaires application and newly medical records clustering, focusing pain report, quality of life, bone scintigraphy and laboratory results. Research instruments were applied in tow moments, in one year interval, the Verbal and Visual Numeric Scale for rating pain, the Margolis drawing rating system [MDRS; 24 body areas (BA) considered], and Brief Pain Inventory (BPI), for evaluating pain. For quality of life appreciation, were used the o Medical Outcomes Study 36 Short- Form Health Survey. The painful BA were related to dysplastic BA (affected BA), according the bone scintigraphy. Results: The sample was composed by 11 patients, being most women (n=8; 72,7%), main racial classification referred white (n=8; 72,7%) and elementary/middle school (n=6; 54,5%). The symptoms outset average 16,8 years (±standard deviation of 13,7 years). Demands at first doctor's appointment was Abstract 6 isolated bone pain (n=4; 36,4%) and isolated bone fracture (n=3; 27,3%). Seven patients had more than one affected bone (63,6%), with five cases (45,6%) presenting two to four dysplastic bone, whilst cranium-facial form happen in three (27,3%). At the priming data gathering, six patients (54,5%) already received pamidronate, while tow initiate treatment behind gathering and three did not received specific treatment. Considering the MDRS, all patients present at least one painful dysplastic BA, according to scintigraphy. The average (± standard deviation) affected BA was 6,54 (± 6,97), corresponding 27,3% of 24 total considered BA. All patients had at least one painful affected BA. The average (± standard deviation) painful areas that was scintigraphy affected was 2,82 (±1,72), corresponding 11,8% of total BA and 43,1% of affected BA, with average rating pain 5,89 (± 2,42). Six patients (54,5%) had related pain in healthy spots according to scintigraphy. The average (± standard deviation) pain healthy spots was 2,72 (± 3,66) corresponding 11,3% of total BA and 15,6% of healthy BA, with rating pain 2,15 (± 2,74). Rating pain was higher in scintigraphy affected BA (p=0,0092). When isolated compared, patients who received treatment whit non treated, one year long, it was observed that, treated ones reduced pain interference to carry out quoted activities (general), into walking ability , and sleep quality (p <0,005). Comparing patients who received treatment whit non treated by grouped data collected in two years of applied questionnaires, about BPI, it was noted that higher percentage of treated patients had to make use of analgesic drugs than non-treated (p=0,00607), there was no difference between groups when subdivided about the analgesic types. Anyone of non-treated patients was in opioid use. Conclusion: In this group of patients, use of pamidronate was associated at the reduction on pain interference at daily aspects, although, it was not observed influence on quality of life.
Descrição
Palavras-chave
Biomarcadores, Terapêutica, Biomarkers, Therapeutics, Displasia fibrosa óssea, Inquéritos e questionários, Qualidade de vida, Chronic pain, Fibrous dysplasia of bone, Surveys and questionnaires, Quality of life, Dor crônica