Lúpus eritematoso sistêmico: estudo comparativo entre modelos de intervenção para adesão ao tratamento

Abstract

Systemic lupus erythematosus (SLE ) is a chronic inflammatory disease of the connective , and multisystem autoimmune tissue, characterized by the production of autoantibodies directed mainly against nuclear antigens resulting in tissue damage . Usually evolves with exacerbation periods interspersed with periods of remission and great polymorphism of clinical manifestations. Occurs mainly in women in the period between menarche and menopause. Treatment is diverse , medications used to control the disease during the activity are indicated according to the clinical manifestations and severity . Among these , glucocorticoids , which due to some side effects such as changes in the aesthetics of patients , may result in lowering of self-esteem . Studies involving this subject can contribute new information and enable advances in knowledge of factors involved in adherence to treatment of these patients. This is a longitudinal study of interventions in intervals of 30 , 60, 90 and 120 days that examined the effects of three intervention conditions on adherence behaviors to treatment in women with SLE. The study included fifteen patients with SLE, according to the American College of Rheumatology criteria, followed up at the referral center in rheumatic diseases of a hospital in the public health system in the city of Belém- PA . The following inclusion criteria were used : diagnosis of SLE for at least one year; is aged between 18 and 45 years; have completed elementary school or to be attending the last year ; reside in the metropolitan area of Belém or municipalities near capital; present moderate level of disease activity , according to SLEDAI - 2K. Were used: observation formats of medical consultations; chart analysis protocols ; interview scripts ; checklist ; self-monitoring registration forms ; visual analogue pain scale ; Beck depression inventory for ( BDI ) ; quality assessment of life questionnaire SF -36 and the Activity Index -SLEDAI -2K disease. The participants were divided randomly into three intervention conditions. In Condition A (n = 5), the participants were only under the control of routine outpatient and 4 interviews. In Condition B (n = 5), the participants were subjected to 8 interviews with use of checklist beyond the routine clinic. In the Condition C (n = 5), they were under the control of ambulatory care and 8 interviews with the use of self-monitoring checklist and registration forms . Data were analyzed quantitatively and qualitatively, comparing the results at the beginning with the end of the study conducted with each participant, for 120 days. It was observed that all participants, regardless of the intervention condition showed good adhesion behavior index at the end of the treatment study. The participants of Condition C kept the gains from the intervention after 30 days without exposure to the rules of treatment (average 95,71).