Orientador: Eliane Chaves Jorge / Resumo: Introdução: Uveítes são afecções relacionadas à inflamação do trato uveal, que quando ocorrem na infância, podem levar à déficit visual importante e até mesmo à cegueira. O manejo das uveítes em crianças pode ser difícil, pelos desafios diagnósticos e terapêuticos inerentes à faixa etária e pelos custos sociais e psicológicos associados à uma eventual cegueira precoce. As uveítes não infecciosas são associadas com frequência a condições sistêmicas, sendo algumas delas exclusivas da infância, como a Artrite Idiopática Juvenil (AIJ). Quando a terapia convencional com corticosteróides e agentes imunossupressores falha no controle da inflamação ocular, os modificadores de resposta biológica, principalmente o infliximabe e o adalimumabe, são opções no tratamento de vários subtipos de uveíte refratária. Porém, o alto custo e a falta de evidências sobre a segurança do uso destas drogas em crianças à longo prazo não as habilita como primeira opção de tratamento. Objetivo: A presente revisão teve como objetivo avaliar a eficácia clínica e a segurança do uso de terapia biológica no tratamento da uveíte infantil não infecciosa. Métodos: Uma revisão sistemática da literatura foi realizada utilizando a metodologia da Colaboração Cochrane e plataformas eletrônicas de busca para identificar ensaios clínicos randomizados (ECRs) e estudos controlados não randomizados (ENRs), que envolvessem a comparação aleatória de qualquer esquema de tratamento para uveíte pediátrica não infecciosa utilizan... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Uveitis are conditions related to inflammation of the uveal tract that, when they occur in childhood, can lead to significant visual impairment and even blindness. The management of uveitis in children can be difficult due to the diagnostic and therapeutic challenges inherent in the age group and the social and psychological costs associated with possible early blindness. Non-infectious uveitis is often associated with systemic conditions, some of which are unique to childhood, such as Juvenile Idiopathic Arthritis (JIA). When conventional corticosteroid and immunosuppressive therapy fails to control ocular inflammation, biological response modifiers, especially infliximab and adalimumab, are options in the treatment of various refractory uveitis subtypes. However, the high cost and lack of evidence on the safety of long-term use of these drugs in children does not make them the first treatment option. Objective: The present review aimed to evaluate the clinical efficacy and safety of using biological therapy in the treatment of noninfectious childhood uveitis. Methods: A systematic literature review was performed using the Cochrane Collaboration methodology and electronic search platforms to identify randomized controlled trials (RCTs) and non-randomized controlled trials (NRTs), involving randomized comparison of any treatment regimen for non-infectious pediatric uveitis using biological therapy alone or in combination with other drugs versus placebo or no tre... (Complete abstract click electronic access below) / Mestre

Autor: Bc. Veronika Sýkorová Title: Comparative analysis of the effect on disease-modifying drugs and biological therapy in functional ability in patients with rheumatoid arthritis. Objective: The aim of the thesis is to compare the effect of disease-modifying drugs and biological therapy on quality of life using the disability index, which is achieved by evaluating the HAQ, grip strength the small muscles of the hand, which is tested a hand dynamometer and standing stability, which is detected by measuring on stabilometric platform. Methods: This is a pilot study using subjective and objective examination. Stabilometric and dynamometric examination and the Czech version of the Stanford Health Assessment Questionnaire validated by Rheumatology Institute in Prague 2010 were used to the analysis. Evaluation of the collected data was done using two-way analysis of variance with repetition. Results: Biological therapy and disease-modifying antirheumatic drugs have significant impact on quality of life, the strength of the small muscles of the hand and standing stability in patients with rheumatoid arthritis. Disease-modifying antirheumatic drugs have reached significant results than the biological therapy in quality of life, forces the small muscles of the right hand and standing stability. Biological...

Susirgus lėtiniais artritais, žymiai pablogėja ligonio gyvenimo kokybė, savirūpa, atsiranda informacijos apie ligą bei jos gydymą poreikis. Tai ypač tampa aktualu pacientams, kuriems taikoma biologinė terapija, kai su liga kovoti nebepadeda įprastas medikamentinis gydymas. Tikslas – ištirti sergančių lėtiniais artritais gyvenimo kokybę, savirūpą ir žinias taikant biologinę terapiją. Uždaviniai: 1) ištirti ir palyginti sergančių lėtiniais artritais gyvenimo kokybę prieš biologinę terapiją ir jos pokyčius po 4 mėn.; 2) ištirti ir palyginti sergančių lėtiniais artritais savirūpą prieš biologinę terapiją ir praėjus 4 mėn. po jos taikymo; 3) įvertinti sergančių lėtiniais artritais žinias apie biologinę terapiją prieš jos taikymą ir praėjus 4 mėn. po jos taikymo. Tyrimo metodai – 2013 m. vasario - spalio mėn. atlikta anoniminė anketinė apklausa. Tyrime dalyvavo LSMU reumatologijos skyriaus pacientai, sergantys lėtiniais artritais: reumatoidiniu artritu, ankiloziniu spondilitu, psoriaziniu artritu, kurie atitiko atrankos kriterijus biologinei terapijai. Tyrimui naudotas ,,SF-36’’ gyvenimo kokybės klausimynas, kasdieninės veiklos klausimynas (HAQ) bei autorės papildomai kurti klausimai. Respondentams buvo pateiktos anketos prieš biologinę terapiją ir po jos, praėjus 4 mėn. Gautas Lietuvos Sveikatos mokslų universiteto Medicinos akademijos Bioetikos centro leidimas 2013-02-07, Nr. BEK - KS(M)-241 tyrimo atlikimui. Rezultatai: analizuojant bendrai gyvenimo kokybės fizinę ir psichinę... [toliau žr. visą tekstą] / In case of the diagnosis with chronic arthritis, patients’ quality of life and self-care start to deteriorate significantly, the need of information about the disease and its treatment arises. It becomes relevant in particular to patients, treated with biological therapy as traditional treatment with drugs is ineffective. The aim – to research the quality of life, self-care and knowledge of chronic arthritis patients treated with biological therapy. Tasks: 1) to research and to compare the quality of life of patients with chronic arthritis prior to biological therapy and its changes in 4 months period, 2) to research and to compare self-care of patients with chronic arthritis prior to biological therapy and after the period of 4 months treatment, 3) to evaluate the knowledge of patients with chronic arthritis about biological therapy prior to its treatment and after 4 months. The research methods – from February till October, 2013 an anonymous questionnaire was conducted. Patients, diagnosed with chronic arthritis such as: rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, corresponding the selection criteria for biological therapy from Rheumatology department at LUHS, partipated in the research. ,,SF-36“ the life quality questionnaire, the health assesment questionnaire ( HAQ) as well as extra questions, made by the author, were applied in the research. Respondents were provided with the questionnaire forms prior to biological therapy and... [to full text]

Orientador: Lígia Yukie sassaki / Resumo: Introdução: Com o advento da terapia biológica, o foco de resposta na Doença de Crohn (DC) ampliou-se, sendo essenciais a remissão clínica e endoscópica. Estudos prospectivos comparando os representantes dessa classe terapêutica mais utilizados, o Infliximabe (IFX) e o Adalimumabe (ADA), são escassos. O objetivo do estudo foi comparar a efetividade clínica e endoscópica do IFX versus ADA em pacientes com DC naïves terapia biológica, na semana 54 de tratamento. Metodologia: Foi realizado um estudo clínico, não-randomizado, no qual pacientes com DC que receberam IFX ou ADA, foram avaliados nas semanas 0, 14, 30 e 54 de tratamento. Utilizou-se o Índice de Atividade da Doença de Crohn (CDAI) para avaliação da atividade clínica da doença. Entre 6 e 12 meses, foi avaliada a atividade endoscópica através do Simplified Endoscopic Score for Crohn’s Disease (SES-CD). As variáveis foram resposta clínica (queda do CDAI > 70 pontos) e remissão clínica (CDAI < 150 pontos), avaliados nas semanas 14, 30 e 54, e resposta endoscópica (queda do SES-CD de pelo menos 50% em relação à pontuação inicial), remissão endoscópica (controle endoscópico com SES-CD ≤ 2 pontos), e taxas de internação, cirurgia, óbito e perda de resposta, analisados na semana 54. A análise estatística foi estatística descritiva, teste de ANOVA com medidas repetidas no tempo considerando a interação medicamento x tempo, seguida do teste de comparação múltipla de Tukey ajustado, com nível de significância de 5% ou o p-valor c... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: With the advent of biological therapy, the focus of the Crohn's Disease (CD) response has changed and clinical and endoscopic remission are essential. Prospective studies comparing the most used biological drugs, Infliximab (IFX) and Adalimumab (ADA), are scarce. Our aim was compare the clinical and endoscopic effectiveness of IFX versus ADA in CD patients naïve to biological therapy at the 54th week of treatment. Methods: An open, non-randomized, clinical study with CD patients receiving IFX or ADA was performed at treatment weeks 0, 14, 30 and 54. The Crohn's Disease Activity Index (CDAI) was used to evaluate the disease clinical activity. Between 6 and 12 months, colonoscopy was performed and the Simplified Endoscopic Score for Crohn's Disease (SES-CD) was used. Clinical response (CDAI decrease>70 points) and clinical remission (CDAI<150 points) were assessed at weeks 14, 30 and 54; endoscopic response (decrease of at least 50% in SES-CD), endoscopic remission (endoscopic control with SES-CD ≤ 2 points), and hospitalization rates, surgeries, deaths and loss of response, were analyzed at week 54. A statistical analysis was descriptive with ANOVA test with repeated measures considering drug interaction x time, followed by Tukey multiple comparison test adjusted, with a significance level of 5% or the corresponding p-value. Results: A total of 85 patients were included, 45 patients underwent treatment with ADA and 40 with IFX, with difference between groups only... (Complete abstract click electronic access below) / Doutor

Orientador: Rogério Saad-Hossne / Coorientador: Lígia Yukie Sassaki / Banca: Fabio Vieira Teixeira / Banca: Luiz Henrique Cury Saad / Resumo: As doenças inflamatórias intestinais vêm se tornando um importante problema de saúde pública no Brasil e no mundo. Embora sua incidência seja relativamente baixa, estudos mostram que pessoas jovens, em idade produtiva são acometidas por essa patologia caracterizada por períodos de atividade e remissão, que altera de forma impactante a qualidade de vida. O tratamento clínico convencional compreende o uso de agentes imunossupressores e imunorreguladores. Destaca-se dentre esses tratamentos a terapia biológica, representada pela classe de fármacos anti fator de necrose tumoral (anti- TNF α). Objetivo: Correlacionar a resposta clínica à qualidade de vida dos pacientes com doença inflamatória tratados com terapia biológica. Métodos: Estudo prospectivo longitudinal realizado no Hospital das Clínicas da Faculdade de Medicina de Botucatu/UNESP, no qual foram avaliados 35 pacientes com doença inflamatória intestinal em uso de terapia biológica, através de questionários de qualidade de vida Inflammatory Bowel Disease Questionnaire (IBDQ) e índices de atividade da Doença de Crohn (DC) CDAI e Escore de Mayo para Retocolite Ulcerativa e Classificação de Montreal doença nas semanas 0, 14,30,54. Resultados: Da população estudada 42,8% eram mulheres, 57,2% homens, 94,3% brancos, 17,1% eram tabagistas, sendo que 77,1% eram acometidos por Doença de Crohn (DC) e 22,8% Retocolite Ulcerativa (RCU). Desses pacientes 65,7% fizeram uso do Infliximabe e 34,3% do Adalimumabe. O tempo médio de doença foi de 6,1 anos (±5,0). Remissão clínica com melhora dos sintomas e cicatrização da mucosa intestinal foi alcançada por 80%dos pacientes. Manifestações perianais foram observadas em 44,4%%, necessitaram de internação 25,7%, cirurgia 25,7%, evoluiu para óbito 2,9%. Nos pacientes respondedores houve melhora estatisticamente significativa em todos os índices de qualidade de vida aplicados. Conclusão: O presente estudo apontou que a... / Abstract: Inflammatory bowel diseases are becoming a major public health problem in Brazil and worldwide. Although their incidence is relatively low, studies show that young people of working age are affected by this disease characterized by periods of activity and remission amending of impactful quality of life. The conventional medical treatment includes the use of immunosuppressive and immunoregulatory agents.It stands out among these treatments biological therapy, represented by the class of tumor necrosis drugs (anti-TNF α). Objective: To correlate the clinical response to the quality of life of patients with inflammatory disease treated with biologic therapy. Methods: A prospective longitudinal study conducted at the Hospital of the Botucatu School of Medicine / UNESP, which evaluated 35 patients with inflammatory bowel disease using biological therapy through Inflammatory quality of life questionnaires Bowel Disease Questionnaire(IBDQ) and Crohn's disease activity index (DC), and CDAI score of Mayo for Ulcerative Colitis and Montreal Rating disease at weeks 0, 14,30,54 Results: 42,8% of the study population were female, 57,2% male, 94,3% white, 17,1% were smokers, and 77,1% were affected by Crohn's disease (CD) and 22.8% Colitis Colitis (UC). Of these patients 65, 7% made use of Infliximab and 34,3% of Adalimumab. The mean disease duration was 6,1 years (± 5,0). Clinical remission with symptom improvement and healing of the intestinal mucosa was achieved by 80% of patients. Perianal manifestations were observed in 44,4 %%, 25,7% required hospitalization, surgery 25,7%, 2,9% progressed to death. In responding patients showed a statistically significant improvement in all the applied life quality scores / Mestre

Made available in DSpace on 2015-10-06T13:03:32Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-05-29. Added 1 bitstream(s) on 2015-10-06T13:18:25Z : No. of bitstreams: 1 000849094.pdf: 851216 bytes, checksum: ca7d30725d25c90cdb2c08d992a287a1 (MD5) / As doenças inflamatórias intestinais vêm se tornando um importante problema de saúde pública no Brasil e no mundo. Embora sua incidência seja relativamente baixa, estudos mostram que pessoas jovens, em idade produtiva são acometidas por essa patologia caracterizada por períodos de atividade e remissão, que altera de forma impactante a qualidade de vida. O tratamento clínico convencional compreende o uso de agentes imunossupressores e imunorreguladores. Destaca-se dentre esses tratamentos a terapia biológica, representada pela classe de fármacos anti fator de necrose tumoral (anti- TNF α). Objetivo: Correlacionar a resposta clínica à qualidade de vida dos pacientes com doença inflamatória tratados com terapia biológica. Métodos: Estudo prospectivo longitudinal realizado no Hospital das Clínicas da Faculdade de Medicina de Botucatu/UNESP, no qual foram avaliados 35 pacientes com doença inflamatória intestinal em uso de terapia biológica, através de questionários de qualidade de vida Inflammatory Bowel Disease Questionnaire (IBDQ) e índices de atividade da Doença de Crohn (DC) CDAI e Escore de Mayo para Retocolite Ulcerativa e Classificação de Montreal doença nas semanas 0, 14,30,54. Resultados: Da população estudada 42,8% eram mulheres, 57,2% homens, 94,3% brancos, 17,1% eram tabagistas, sendo que 77,1% eram acometidos por Doença de Crohn (DC) e 22,8% Retocolite Ulcerativa (RCU). Desses pacientes 65,7% fizeram uso do Infliximabe e 34,3% do Adalimumabe. O tempo médio de doença foi de 6,1 anos (±5,0). Remissão clínica com melhora dos sintomas e cicatrização da mucosa intestinal foi alcançada por 80%dos pacientes. Manifestações perianais foram observadas em 44,4%%, necessitaram de internação 25,7%, cirurgia 25,7%, evoluiu para óbito 2,9%. Nos pacientes respondedores houve melhora estatisticamente significativa em todos os índices de qualidade de vida aplicados. Conclusão: O presente estudo apontou que a... / Inflammatory bowel diseases are becoming a major public health problem in Brazil and worldwide. Although their incidence is relatively low, studies show that young people of working age are affected by this disease characterized by periods of activity and remission amending of impactful quality of life. The conventional medical treatment includes the use of immunosuppressive and immunoregulatory agents.It stands out among these treatments biological therapy, represented by the class of tumor necrosis drugs (anti-TNF α). Objective: To correlate the clinical response to the quality of life of patients with inflammatory disease treated with biologic therapy. Methods: A prospective longitudinal study conducted at the Hospital of the Botucatu School of Medicine / UNESP, which evaluated 35 patients with inflammatory bowel disease using biological therapy through Inflammatory quality of life questionnaires Bowel Disease Questionnaire(IBDQ) and Crohn's disease activity index (DC), and CDAI score of Mayo for Ulcerative Colitis and Montreal Rating disease at weeks 0, 14,30,54 Results: 42,8% of the study population were female, 57,2% male, 94,3% white, 17,1% were smokers, and 77,1% were affected by Crohn's disease (CD) and 22.8% Colitis Colitis (UC). Of these patients 65, 7% made use of Infliximab and 34,3% of Adalimumab. The mean disease duration was 6,1 years (± 5,0). Clinical remission with symptom improvement and healing of the intestinal mucosa was achieved by 80% of patients. Perianal manifestations were observed in 44,4 %%, 25,7% required hospitalization, surgery 25,7%, 2,9% progressed to death. In responding patients showed a statistically significant improvement in all the applied life quality scores

Submitted by JÚLIO PINHEIRO BAIMA (jpbaima@yahoo.com.br) on 2018-04-25T20:09:46Z No. of bitstreams: 1 Tese Doutorado Julio Pinheiro Baima 25 abril 2018.pdf: 1976761 bytes, checksum: fade6f9adcb14ae4ad0854e9274f5c9d (MD5) / Approved for entry into archive by Sulamita Selma C Colnago null (sulamita@btu.unesp.br) on 2018-04-26T19:04:00Z (GMT) No. of bitstreams: 1 baima_jp_dr_bot_int.pdf: 1976761 bytes, checksum: fade6f9adcb14ae4ad0854e9274f5c9d (MD5) / Made available in DSpace on 2018-04-26T19:04:00Z (GMT). No. of bitstreams: 1 baima_jp_dr_bot_int.pdf: 1976761 bytes, checksum: fade6f9adcb14ae4ad0854e9274f5c9d (MD5) Previous issue date: 2018-02-27 / Introdução: Com o advento da terapia biológica, o foco de resposta na Doença de Crohn (DC) ampliou-se, sendo essenciais a remissão clínica e endoscópica. Estudos prospectivos comparando os representantes dessa classe terapêutica mais utilizados, o Infliximabe (IFX) e o Adalimumabe (ADA), são escassos. O objetivo do estudo foi comparar a efetividade clínica e endoscópica do IFX versus ADA em pacientes com DC naïves terapia biológica, na semana 54 de tratamento. Metodologia: Foi realizado um estudo clínico, não-randomizado, no qual pacientes com DC que receberam IFX ou ADA, foram avaliados nas semanas 0, 14, 30 e 54 de tratamento. Utilizou-se o Índice de Atividade da Doença de Crohn (CDAI) para avaliação da atividade clínica da doença. Entre 6 e 12 meses, foi avaliada a atividade endoscópica através do Simplified Endoscopic Score for Crohn’s Disease (SES-CD). As variáveis foram resposta clínica (queda do CDAI > 70 pontos) e remissão clínica (CDAI < 150 pontos), avaliados nas semanas 14, 30 e 54, e resposta endoscópica (queda do SES-CD de pelo menos 50% em relação à pontuação inicial), remissão endoscópica (controle endoscópico com SES-CD ≤ 2 pontos), e taxas de internação, cirurgia, óbito e perda de resposta, analisados na semana 54. A análise estatística foi estatística descritiva, teste de ANOVA com medidas repetidas no tempo considerando a interação medicamento x tempo, seguida do teste de comparação múltipla de Tukey ajustado, com nível de significância de 5% ou o p-valor correspondente. Resultados: Foram incluídos 85 pacientes, 45 submetidos ao tratamento com ADA e 40 com IFX. O uso concomitante de Azatioprina foi mais frequente no grupo que recebeu IFX (p=0,0001). As taxas de resposta clínica foram de 86,67% na semana 14, 82,22% na semana 30 e 82,22% na semana 54 no grupo ADA. No grupo IFX, as taxas de resposta foram 70%, 72,5% e 75%, respectivamente, sem diferença entre os tratamentos (p>0,05 em todas as semanas). As taxas de remissão clínica no grupo ADA foram de 86,67% na semana 14, 80% na semana 30 e 82,22% na Resumo 3 semana 54. No grupo IFX, 65%, 62,5% e 65% respectivamente, com diferença significativa apenas na semana 14 (p=0,02). Resposta endoscópica foi atingida em 60,61% dos pacientes do grupo ADA e 85,71% no grupo IFX (p=0,02). As taxas de remissão endoscópica foram de 45,45% e 60%, respectivamente (p=0,23). Internações, cirurgia, óbitos e perda de resposta ocorreram com frequência sem diferença significativa entre os grupos. Conclusões: Não houve diferença nas taxas de resposta clínica entre os tratamentos. Houve maiores taxas de remissão clínica na semana 14 no grupo ADA, não mantidas nas semanas seguintes. Taxas de resposta endoscópica foram melhores no grupo IFX. Não houve diferença nas taxas de remissão endoscópica. Não houve diferença nas taxas de internações, cirurgias e óbitos, assim como na perda de resposta. / Introduction: With the advent of biological therapy, the focus of the Crohn's Disease (CD) response has changed and clinical and endoscopic remission are essential. Prospective studies comparing the most used biological drugs, Infliximab (IFX) and Adalimumab (ADA), are scarce. Our aim was compare the clinical and endoscopic effectiveness of IFX versus ADA in CD patients naïve to biological therapy at the 54th week of treatment. Methods: An open, non-randomized, clinical study with CD patients receiving IFX or ADA was performed at treatment weeks 0, 14, 30 and 54. The Crohn's Disease Activity Index (CDAI) was used to evaluate the disease clinical activity. Between 6 and 12 months, colonoscopy was performed and the Simplified Endoscopic Score for Crohn's Disease (SES-CD) was used. Clinical response (CDAI decrease>70 points) and clinical remission (CDAI<150 points) were assessed at weeks 14, 30 and 54; endoscopic response (decrease of at least 50% in SES-CD), endoscopic remission (endoscopic control with SES-CD ≤ 2 points), and hospitalization rates, surgeries, deaths and loss of response, were analyzed at week 54. A statistical analysis was descriptive with ANOVA test with repeated measures considering drug interaction x time, followed by Tukey multiple comparison test adjusted, with a significance level of 5% or the corresponding p-value. Results: A total of 85 patients were included, 45 patients underwent treatment with ADA and 40 with IFX, with difference between groups only in concomitant use of azathioprine, more frequent in the IFX group (p=0.0001). Clinical response rates were 86.67% at week 14, 82.22% at week 30 and 82.22% at week 54 in ADA group. In IFX group, 70%, 72.5% and 75%, respectively (p> 0.05 on all weeks). Clinical remission rates were 86.67% at week 14, 80% at week 30 and 82.22% at week 54 in ADA group. In IFX group, 65%, 62.5% and 65%, respectively, with significate difference only at week 14 (p = 0.02). Endoscopic response rate was 60.61% in patients from ADA group and 85.71% in the IFX group (p = 0.02). Rates of Abstract 6 endoscopic remission were 45.45% and 60%, respectively (p = 0.23). Hospitalizations, surgery, deaths and loss of lost response occurred without significant difference between groups. Conclusions: There were no difference in the clinical response rates between treatments. There was higher rate of clinical remission at week 14 in the ADA group, not sustained in the subsequent weeks. Endoscopic response rate was better in the IFX group. There was no difference in endoscopic remission rate. There were no difference in hospitalization rates, surgeries and deaths, as well as loss of response.

Despite advancements in the treatment of individuals with Inflammatory Bowel Disease (IBD), many patients will require the need to utilize biological therapies during their disease course. Moreover, some patients with IBD develop disease manifestations outside of the GI (gastrointestinal) tract termed extraintestinal manifestations (EIM). We sought to establish an association between prior EIM exposure and the sequential use of biological therapies in patients with IBD. A retrospective analysis of 555 patients with confirmed IBD and relevant EIM data was performed. EIM exposure was treated as both a dichotomized (ever, never) variable and a categorical (0, 1, 2 or more) variable in our analysis. Crude ratios were established using logistic regression and multinomial regression models. Bivariate analysis was used to test for significant confounding variables and significant confounders were included in the final multivariate regression model. We found female sex (p < 0.001), a disease duration of 13 years or longer (p = 0.001), and an ileocolonic disease location (p = 0.036) to be significantly associated with EIM exposure. We found that a disease duration of 13 years or longer (p = 0.037), diagnosis of Crohn’s Disease (CD) (p < 0.001), corticosteroid use (p < 0.001), and an ileocolonic disease location (p = 0.021) to be significantly associated with use of biologics. Our final adjusted model did not show statistical significance, but did notably indicate that individuals exposed to 2 or more EIM had 1.51 times the odds of progressing to biological therapy (95%CI: 0.67, 3.41; p = 0.32) compared to those patients with no EIM history. As a result, EIM exposure may be an indicator for high-risk IBD patients likely to require biological therapy, especially among particular groups. Our data emphasizes the need for further studies to characterize the association between EIM exposure and specific EIM with the utilization of biologics.

Esta dissertação analisa o Sanatório São José, uma instituição psiquiátrica particular criada no ano de 1934 na cidade de Porto Alegre, Rio Grande do Sul. O recorte temporal proposto para a pesquisa inicia com o contexto de criação do referido estabelecimento e encerra no decorrer da década de 1950 quando ocorre a introdução e a disseminação do uso de medicamentos para o tratamento psiquiátrico, o que imprime uma mudança no cotidiano e na prática institucional. Parte-se desta instituição para examinar a prática psiquiátrica de forma ampla, examina-se nesse sentido o contexto que legitimava o funcionamento de estabelecimentos desta natureza, a atuação dos psiquiatras como profissionais autorizados pela sociedade e as práticas terapêuticas desenvolvidas na instituição. Utilizam-se como fonte, sobretudo, as pastas dos pacientes internados neste estabelecimento, sendo estas de responsabilidade do Arquivo da Clínica São José. A pesquisa que segue esta dividida em três capítulos: no primeiro capítulo analisa-se o contexto da assistência psiquiátrica no Rio Grande do Sul durante as décadas de 1920 e 1930, compondo o ambiente no qual se desenvolveu a ideia da criação de um Sanatório particular. Os agentes envolvidos na criação desta instituição e os profissionais que atuaram naquele espaço – os psiquiatras e as religiosas – são analisados ainda neste espaço. No segundo capítulo, a partir dos dados presentes nos questionários iniciais – Boletins de internamento – e nas anotações clínicas presentes nas pastas dos pacientes, examinamos as concepções de alienação mental que compartilhavam aqueles que procuravam este estabelecimento, as formas como se justificava a internação, as atitudes e hábitos flagrantes de alienação mental. No decorrer do terceiro capítulo, que conclui este trabalho, ocupamo-nos dos tratamentos desenvolvidos pelos psiquiatras do Sanatório São José, traçando os referenciais teóricos e ideológicos que orientavam estas práticas, as resistências a estas terapêuticas e conclui-se esta dissertação com a análise das concepções de cura da alienação mental a partir da ação de uma instituição privada. / This dissertation analyzes the São José Sanatorium, a private psychiatric institution created in 1934 in Porto Alegre, Rio Grande do Sul. The time proposed for the survey starts with the context of the creation of that establishment and closes during the decade 1950 when occurs the introduction and use of drugs for psychiatric treatment, which prints a change in daily life and in institutional practice. Starting of this institution is to examine the psychiatric practice broadly; it examines that effect the context that legitimized the operation of establishments of this nature, the actions of psychiatrists as licensed professionals by society and therapeutic practices developed in the institution. Use’s as a source above all the folders of patients admitted at this property, which are the responsibility of the Archive of São José Sanatorium. The research that follows is divided into three chapters:, in the first chapter analyzes the context of psychiatric care in Rio Grande do Sul during the 1920s and 1930s, making the environment in which they developed the idea of creating a private sanatorium. Agents involved in the creation of this institution and the professionals who worked in that space - the psychiatrists and religious - are also analyzed in this space. In the second chapter, from the data present in the initial questionnaires - inpatient Bulletins - and the clinical notes present in the folders of patients, we examine the mental alienation concepts they shared those seeking this establishment, the ways in which he justified hospital admission, attitudes and blatant insanity habits. During the third chapter, which concludes this work we deal with the treatments developed by psychiatrists in the São José Sanatorium, tracing the theoretical and ideological references that guided these practices, resistance to these therapies and concludes this essay with the analysis of healing conceptions of mental illness from the action of a private institution.

Esta dissertação analisa o Sanatório São José, uma instituição psiquiátrica particular criada no ano de 1934 na cidade de Porto Alegre, Rio Grande do Sul. O recorte temporal proposto para a pesquisa inicia com o contexto de criação do referido estabelecimento e encerra no decorrer da década de 1950 quando ocorre a introdução e a disseminação do uso de medicamentos para o tratamento psiquiátrico, o que imprime uma mudança no cotidiano e na prática institucional. Parte-se desta instituição para examinar a prática psiquiátrica de forma ampla, examina-se nesse sentido o contexto que legitimava o funcionamento de estabelecimentos desta natureza, a atuação dos psiquiatras como profissionais autorizados pela sociedade e as práticas terapêuticas desenvolvidas na instituição. Utilizam-se como fonte, sobretudo, as pastas dos pacientes internados neste estabelecimento, sendo estas de responsabilidade do Arquivo da Clínica São José. A pesquisa que segue esta dividida em três capítulos: no primeiro capítulo analisa-se o contexto da assistência psiquiátrica no Rio Grande do Sul durante as décadas de 1920 e 1930, compondo o ambiente no qual se desenvolveu a ideia da criação de um Sanatório particular. Os agentes envolvidos na criação desta instituição e os profissionais que atuaram naquele espaço – os psiquiatras e as religiosas – são analisados ainda neste espaço. No segundo capítulo, a partir dos dados presentes nos questionários iniciais – Boletins de internamento – e nas anotações clínicas presentes nas pastas dos pacientes, examinamos as concepções de alienação mental que compartilhavam aqueles que procuravam este estabelecimento, as formas como se justificava a internação, as atitudes e hábitos flagrantes de alienação mental. No decorrer do terceiro capítulo, que conclui este trabalho, ocupamo-nos dos tratamentos desenvolvidos pelos psiquiatras do Sanatório São José, traçando os referenciais teóricos e ideológicos que orientavam estas práticas, as resistências a estas terapêuticas e conclui-se esta dissertação com a análise das concepções de cura da alienação mental a partir da ação de uma instituição privada. / This dissertation analyzes the São José Sanatorium, a private psychiatric institution created in 1934 in Porto Alegre, Rio Grande do Sul. The time proposed for the survey starts with the context of the creation of that establishment and closes during the decade 1950 when occurs the introduction and use of drugs for psychiatric treatment, which prints a change in daily life and in institutional practice. Starting of this institution is to examine the psychiatric practice broadly; it examines that effect the context that legitimized the operation of establishments of this nature, the actions of psychiatrists as licensed professionals by society and therapeutic practices developed in the institution. Use’s as a source above all the folders of patients admitted at this property, which are the responsibility of the Archive of São José Sanatorium. The research that follows is divided into three chapters:, in the first chapter analyzes the context of psychiatric care in Rio Grande do Sul during the 1920s and 1930s, making the environment in which they developed the idea of creating a private sanatorium. Agents involved in the creation of this institution and the professionals who worked in that space - the psychiatrists and religious - are also analyzed in this space. In the second chapter, from the data present in the initial questionnaires - inpatient Bulletins - and the clinical notes present in the folders of patients, we examine the mental alienation concepts they shared those seeking this establishment, the ways in which he justified hospital admission, attitudes and blatant insanity habits. During the third chapter, which concludes this work we deal with the treatments developed by psychiatrists in the São José Sanatorium, tracing the theoretical and ideological references that guided these practices, resistance to these therapies and concludes this essay with the analysis of healing conceptions of mental illness from the action of a private institution.