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ex&#46;&#44; depress&#227;o e transtorno de ansiedade&#41; que compromete a produtividade laboral e o relacionamento interpessoal e eleva o risco de suic&#237;dio&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">8&#8211;11</span></a> No Brasil&#44; a preval&#234;ncia de psor&#237;ase &#233; estimada entre 1&#44;10&#37; e 1&#44;51&#37;&#59; entretanto&#44; em idosos&#44; essa estimativa se eleva para 1&#44;71&#37; a 2&#44;84&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">12</span></a> O aumento da expectativa de vida da popula&#231;&#227;o alude ao crescimento na preval&#234;ncia de doen&#231;as cr&#244;nicas na popula&#231;&#227;o&#44; e entre elas&#44; a psor&#237;ase&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Considera&#231;&#245;es especiais devem ser feitas acerca da assist&#234;ncia &#224; popula&#231;&#227;o geri&#225;trica&#44; que tende a apresentar m&#250;ltiplas comorbidades e utilizar diversos medicamentos concomitantemente&#44; 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Frequentemente&#44; idosos s&#227;o exclu&#237;dos dos ensaios cl&#237;nicos&#44; por serem considerados grupo de risco para eventos adversos aos tratamentos&#46;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">13&#44;16&#8211;18</span></a> Tamb&#233;m s&#227;o escassos os dados quanto &#224; efic&#225;cia e seguran&#231;a de medicamentos sist&#234;micos e imunobiol&#243;gicos nessa faixa et&#225;ria&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">19</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Este estudo objetivou caracterizar vari&#225;veis cl&#237;nico&#8208;demogr&#225;ficas&#44; presen&#231;a de comorbidades&#44; fragilidade f&#237;sica e o impacto afetivo em idosos portadores de psor&#237;ase atendidos em servi&#231;o de dermatologia de refer&#234;ncia&#44; assim como comparar esses aspectos com adultos com psor&#237;ase e idosos sem a doen&#231;a&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Casu&#237;stica e m&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Conduziu&#8208;se estudo transversal &#40;utilizando duas popula&#231;&#245;es de controle&#41; envolvendo 64 pacientes com psor&#237;ase maiores que 60 anos de idade&#44; 64 pacientes com psor&#237;ase com menos de 50 anos de idade e 64 idosos sem psor&#237;ase&#46; O estudo foi conduzido no ambulat&#243;rio de dermatologia da Universidade Estadual Paulista&#44; entre mar&#231;o de 2019 e mar&#231;o de 2021&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A amostragem aconteceu por conveni&#234;ncia&#44; e foram inclu&#237;dos casos e controles eleg&#237;veis&#44; consecutivamente&#44; durante os atendimentos m&#233;dicos&#46; Pacientes com psor&#237;ase &#40;idosos e adultos&#41; eram oriundos do ambulat&#243;rio de psor&#237;ase do servi&#231;o&#46; Os controles idosos eram portadores de outras doen&#231;as dermatol&#243;gicas localizadas que frequentavam o ambulat&#243;rio de Dermatologia ou eram acompanhantes dos pacientes&#46; N&#227;o foram inclu&#237;dos no estudo indiv&#237;duos com dificuldade de compreens&#227;o ou interpreta&#231;&#227;o&#44; pacientes sem les&#245;es cl&#237;nicas de psor&#237;ase ao exame e portadores de outras dermatoses extensas&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">O projeto foi aprovado pelo Comit&#234; de &#201;tica em Pesquisa da institui&#231;&#227;o &#40;FMB&#8208;Unesp n&#176; 3&#46;318&#46;242&#41;&#44; e todos os participantes assinaram o termo de consentimento esclarecido&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Idosos com psor&#237;ase &#40;IPso&#41;&#44; idosos sem psor&#237;ase &#40;ISem&#41; e adultos com psor&#237;ase &#40;APso&#41; foram caracterizados quanto aspectos demogr&#225;ficos&#44; antropom&#233;tricos&#44; tratamento atual&#44; tabagismo&#44; consumo de &#225;lcool&#44; escala de depress&#227;o de Beck e as principais comorbidades&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">20</span></a> Idosos &#40;IPso e ISem&#41; foram avaliados quanto &#224; fragilidade f&#237;sica pelo teste da cadeira&#44; for&#231;a de preens&#227;o manual &#40;<span class="elsevierStyleItalic">handgrip</span>&#41;&#44; perda ponderal e fadiga&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">21</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">A escala de Beck para autoavalia&#231;&#227;o da depress&#227;o &#233; composta por 21 itens que abrangem os componentes cognitivos&#44; afetivos&#44; comportamentais e som&#225;ticos da depress&#227;o&#46; Cada item cont&#233;m quatro afirma&#231;&#245;es que variam quanto &#224; intensidade &#40;0 a 3&#41;&#44; cabendo ao questionado indicar qual das quatro afirma&#231;&#245;es mais bem descreve seus sintomas&#46; O escore final &#233; obtido mediante o somat&#243;rio dos 21 itens que comp&#245;em a escala&#44; resultando na seguinte normatiza&#231;&#227;o&#58; a&#41; nenhuma depress&#227;o ou depress&#227;o m&#237;nima&#58; escores finais &#60;<span class="elsevierStyleHsp" style=""></span>11 pontos&#59; b&#41; depress&#227;o leve a moderada&#58; escores finais entre 12 a 19 pontos&#59; c&#41; depress&#227;o moderada a grave&#58; escores finais entre 20 a 35 pontos&#59; e d&#41; depress&#227;o grave&#58; escores finais entre 36 a 63 pontos&#46;<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">22&#44;23</span></a> A escala de Beck &#233; um dos instrumentos mais utilizados para a avalia&#231;&#227;o do transtorno depressivo e suas vari&#225;veis&#44; aplicada em pacientes psiqui&#225;tricos e n&#227;o psiqui&#225;tricos&#44; validada em outros pa&#237;ses e confirmada quanto aos crit&#233;rios de confiabilidade e validade&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">O teste da cadeira fornece avalia&#231;&#227;o indireta do desempenho f&#237;sico dos pacientes&#44; que foram orientados a levantar&#8208;se e sentar&#8208;se de uma cadeira de altura normal &#40;aproximadamente 48<span class="elsevierStyleHsp" style=""></span>cm&#41; cinco vezes consecutivas&#44; sem apoio das m&#227;os&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">24</span></a> A for&#231;a de preens&#227;o manual&#44; crit&#233;rio indireto de for&#231;a muscular&#44; foi mensurada por <span class="elsevierStyleItalic">handgrip</span>&#44; por meio de um dinam&#244;metro manual &#40;<span class="elsevierStyleItalic">hand dynamometer</span> DRP&#8208;120&#41;&#44; na m&#227;o dominante de cada paciente&#44; e foi considerada a maior medida &#40;em kg&#41; dentre tr&#234;s tentativas realizadas&#46; Perda ponderal foi caracterizada pela redu&#231;&#227;o de mais que 5&#37; do seu peso nos &#250;ltimos tr&#234;s anos&#46; A avali&#231;&#227;o da fadiga&#44; segundo o Consenso Brasileiro de Fragilidade em Idosos&#44; foi realizada por meio do questionamento direto para o paciente se o mesmo se sentia &#8220;cheio de energia&#8221; naquele exato momento&#46;<a class="elsevierStyleCrossRefs" href="#bib0400"><span class="elsevierStyleSup">25&#44;26</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Os pacientes com psor&#237;ase foram submetidos &#224; avalia&#231;&#227;o cl&#237;nica pelo escore PASI &#40;Psoriasis Area Severity Index&#41;&#44; escore BSA &#40;Body Surface Area&#41;&#44; escore PGA &#40;Physician Global Assessment&#41; para o couro cabeludo e corpo&#44; avaliados por dermatologista titulado&#44; al&#233;m do question&#225;rio de qualidade de vida Skindex&#8208;16&#44; validado para o portugu&#234;s do Brasil&#46;<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">27&#8211;29</span></a> A consist&#234;ncia interna das escalas de Beck e das dimens&#245;es do Skindex&#8208;16 foram avaliadas pelo coeficiente McDonald&#39;s &#969;&#44; e seu intervalo de confian&#231;a de 95&#37; &#40;95&#37; IC&#41;&#46; Vari&#225;veis quantitativas e ordinais foram descritas como percentuais&#44; e comparadas pelo teste do Qui&#8208;quadrado de tend&#234;ncia e an&#225;lise dos res&#237;duos da tabela de conting&#234;ncia &#40;<span class="elsevierStyleItalic">post hoc</span>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">30</span></a> Vari&#225;veis quantitativas foram descritas como m&#233;dia e desvio&#8208;padr&#227;o ou mediana e quartis &#40;p25&#8211;p75&#41;&#44; se a normalidade n&#227;o fosse verificada pelo teste de Shapiro&#8208;Wilk&#46;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">31</span></a> As correla&#231;&#245;es entre vari&#225;veis quantitativas foram avaliadas pelo coeficiente rho de Spearman&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">32</span></a> Os grupos foram comparados entre si por modelos de regress&#227;o &#40;log&#8208;linear&#41; de Poisson&#44; e a dimens&#227;o do efeito foi expressa pela raz&#227;o de preval&#234;ncia &#40;RP&#41; e seu 95&#37; IC&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">33</span></a> Dados foram tabulados em MS Excel 2010 e analisados pelo <span class="elsevierStyleItalic">software</span> IBM SPSS 25&#46; Considerou&#8208;se significante p&#8208;valor &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">34</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">A amostra foi dimensionada a partir de um pr&#233;&#8208;teste com 64 participantes em cada grupo de idosos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>128&#41;&#44; com base na estimativa para a regress&#227;o &#40;log&#8208;linear&#41; de Poisson para a compara&#231;&#227;o entre as vari&#225;veis de fragilidade f&#237;sica&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">35</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0070" class="elsevierStylePara elsevierViewall">Os principais dados demogr&#225;ficos dos participantes do estudo est&#227;o dispostos na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46; Destacam&#8208;se o grupo ISem com maior renda familiar&#59; j&#225; o grupo APso apresentou maior escolaridade&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Quanto ao aspecto cl&#237;nico e terap&#234;utico da psor&#237;ase &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#44; os grupos IPso e APso apresentaram par&#226;metros cl&#237;nicos compar&#225;veis&#44; por&#233;m&#44; diferiram quanto &#224; idade de in&#237;cio da doen&#231;a e quanto ao uso de corticoterapia t&#243;pica&#46; As classes de imunobiol&#243;gicos utilizadas pelos IPso foram anti&#8208;TNF alfa &#40;etanercepte&#44; infliximabe e adalimumabe&#41; e anti IL&#8208;17A &#40;secuquinumabe&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Entre os IPso&#44; cinco pacientes &#40;7&#44;8&#37;&#59; 95&#37; IC 1&#44;6&#8211;15&#44;0&#41; apresentaram o in&#237;cio da doen&#231;a ap&#243;s os 60 anos de idade&#46; Quando ajustado pela idade atual e sexo&#44; os pacientes IPso com in&#237;cio da doen&#231;a na terceira idade n&#227;o apresentaram gravidade cl&#237;nica&#44; fragilidade f&#237;sica&#44; frequ&#234;ncia de comorbidades ou comprometimento afetivo que diferissem dos IPso com in&#237;cio da doen&#231;a antes dos 60 anos de idade &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;1&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">O invent&#225;rio Skindex&#8208;16 apresentou adequada consist&#234;ncia interna &#40;McDonald&#39;s &#969;&#41; &#62;<span class="elsevierStyleHsp" style=""></span>0&#44;82&#44; para as tr&#234;s dimens&#245;es&#44; n&#227;o havendo diferen&#231;a dos escores entre os grupos&#46; A dimens&#227;o funcional foi a mais correlata com o escore de Beck &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;471&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#59; por&#233;m&#44; n&#227;o se associou &#224; presen&#231;a de artrite &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;131&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a> apresenta a compara&#231;&#227;o dos principais elementos cl&#237;nico&#8208;demogr&#225;ficos&#44; aspectos afetivos e &#237;ndices de fragilidade entre os grupos&#46; Houve aumento na preval&#234;ncia de comorbidades entre IPso e APso&#44; como hipertens&#227;o&#44; dislipidemia e diabetes&#46; J&#225; quando comparado IPso com ISem&#44; al&#233;m de mais comorbidades ligadas &#224; s&#237;ndrome metab&#243;lica&#44; como hipertens&#227;o arterial sist&#234;mica e dislipidemia&#44; houve maior preval&#234;ncia de fadiga e depress&#227;o&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">A escala de Beck apresentou alta consist&#234;ncia interna&#59; o coeficiente McDonald&#39;s &#969; resultou 0&#44;86 &#40;95&#37; IC 0&#44;83&#8211;0&#44;89&#41;&#46; Os itens B1 &#40;sentimento de tristeza&#41; e B15 &#40;capacidade de trabalhar&#41; foram proeminentes &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; na diferen&#231;a entre IPso e ISem&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Em pacientes com psor&#237;ase&#44; os portadores de artrite apresentaram menor for&#231;a m&#233;dia de preens&#227;o &#40;5&#44;1 <span class="elsevierStyleItalic">vs</span>&#46; 10&#44;0<span class="elsevierStyleHsp" style=""></span>kg&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;030&#41;&#44; por&#233;m artrite n&#227;o foi determinante do desempenho no teste da cadeira ou de fadiga &#40;p &#62;<span class="elsevierStyleHsp" style=""></span>0&#44;760&#41;&#46; Quanto aos escores de Beck&#44; eles foram mais elevados para os idosos que referiam fadiga e perda ponderal &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0105" class="elsevierStylePara elsevierViewall">Nesta amostra brasileira de pacientes atendidos em centro de refer&#234;ncia&#44; idosos com psor&#237;ase apresentaram idade m&#233;dia de in&#237;cio da psor&#237;ase ap&#243;s a quarta d&#233;cada&#44; n&#227;o houve prefer&#234;ncia por sexo e as caracter&#237;sticas cl&#237;nicas&#44; al&#233;m do impacto na qualidade de vida&#44; n&#227;o diferiram dos adultos com psor&#237;ase atendidos no mesmo ambulat&#243;rio&#46; Apesar disso&#44; apresentaram maior preval&#234;ncia de sintomas depressivos&#44; elementos de fragilidade f&#237;sica e par&#226;metros de s&#237;ndrome metab&#243;lica que idosos sem psor&#237;ase&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Cerca de 10&#37; dos casos de psor&#237;ase atendidos na pr&#225;tica dermatol&#243;gica s&#227;o pacientes idosos&#59; no entanto&#44; essa preval&#234;ncia vem crescendo e espera&#8208;se que aumente com o envelhecimento da popula&#231;&#227;o&#46;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">13&#44;36</span></a> Al&#233;m da longevidade&#44; o acesso da popula&#231;&#227;o &#224; informa&#231;&#227;o sobre a doen&#231;a e ao sistema de sa&#250;de para confirma&#231;&#227;o do diagn&#243;stico s&#227;o fatores que podem implicar no aumento da incid&#234;ncia de psor&#237;ase como um todo nas &#250;ltimas d&#233;cadas&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Entre os pacientes idosos com psor&#237;ase&#44; podemos dividi&#8208;los entre os que tiveram o in&#237;cio da doen&#231;a durante a senesc&#234;ncia &#40;ap&#243;s 60 anos de idade&#41;&#44; que corresponde a 3&#37; a 13&#37; dos casos&#44; e os que a iniciaram mais precocemente &#40;antes dos 60 anos&#41;&#46; Espera&#8208;se que a psor&#237;ase de in&#237;cio ap&#243;s os 60 anos tenha quadro cl&#237;nico mais brando&#44; com menores &#237;ndices de BSA&#44; acometimento ungueal e articular&#44; em compara&#231;&#227;o aos pacientes com in&#237;cio mais precoce&#46; No entanto&#44; s&#227;o raros os estudos dedicados a sua caracteriza&#231;&#227;o&#44; j&#225; que a representa&#231;&#227;o da popula&#231;&#227;o geri&#225;trica nos ensaios cl&#237;nicos ainda &#233; escassa&#46;<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">37&#44;38</span></a> Apenas 15&#37; dessa popula&#231;&#227;o desenvolve psor&#237;ase moderada a grave e necessita de tratamentos sist&#234;micos&#46; Em nossa amostra&#44; n&#227;o observamos diferen&#231;a entre a distribui&#231;&#227;o de PASI&#44; BSA&#44; PGA corpo&#47;couro cabeludo&#44; acometimento palmoplantar ou ungueal e atrite entre os dois grupos de pacientes portadores de psor&#237;ase &#40;IPso e APso&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Em amostra de 156 iranianos idosos com psor&#237;ase&#44; foram avaliadas caracter&#237;sticas demogr&#225;ficas&#44; comorbidades&#44; idade de in&#237;cio da doen&#231;a&#44; forma cl&#237;nica predominante&#44; gravidade e abordagens terap&#234;uticas&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">36</span></a> A caracter&#237;stica cl&#237;nica mais comum da doen&#231;a foi o tipo placa &#40;73&#44;1&#37;&#41;&#44; seguida pelo tipo pustulosa &#40;10&#44;9&#37;&#41;&#44; e o local mais frequentemente envolvido foram as extremidades &#40;84&#44;6&#37;&#41;&#46; Couro cabeludo&#44; unhas e articula&#231;&#245;es foram envolvidos em 26&#44;9&#37;&#44; 40&#44;3&#37; e 19&#44;2&#37; dos pacientes avaliados&#44; respectivamente&#46; A pontua&#231;&#227;o m&#233;dia do PASI encontrada foi de 5&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;5&#46; Hipertens&#227;o &#40;25&#37;&#41; e diabetes <span class="elsevierStyleItalic">mellitus</span> &#40;16&#37;&#41; foram as doen&#231;as mais prevalentes&#46; Em rela&#231;&#227;o &#224; abordagem terap&#234;utica dos pacientes&#44; a maioria foi tratada topicamente &#40;81&#44;7&#37;&#41;&#44; e dentre os tratamentos sist&#234;micos&#44; o metotrexato e a acitretina foram os mais frequentes&#44; respons&#225;veis por 74&#44;4&#37; e 60&#44;3&#37; dos pacientes&#46; Os homens apresentaram menor m&#233;dia de idade de in&#237;cio da doen&#231;a &#40;51&#44;8 anos&#41; em compara&#231;&#227;o com as mulheres &#40;59&#44;2 anos&#41;&#46; Pacientes com envolvimento articular apresentaram menor m&#233;dia de idade &#40;65&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;3 anos&#41; quando comparados &#224;queles sem esse envolvimento &#40;69&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;4 anos&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">39</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Idade &#233; fator de risco adicional para hipertens&#227;o&#44; dislipidemia&#44; depress&#227;o e diabetes tipo 2&#46; Em nossa amostra de idosos com psor&#237;ase&#44; esses par&#226;metros foram mais prevalentes que nos controles idosos&#46; De fato&#44; quando comparados a controles saud&#225;veis&#44; os portadores de psor&#237;ase apresentam aumento da preval&#234;ncia de dislipidemia&#44; hipertens&#227;o&#44; doen&#231;a arterial coronariana&#44; diabetes tipo 2 e aumento do &#237;ndice de massa corporal &#40;IMC&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0450"><span class="elsevierStyleSup">35&#44;40&#8211;42</span></a> Esses elementos podem corroborar para maior mortalidade cardiovascular entre portadores de psor&#237;ase&#46;<a class="elsevierStyleCrossRefs" href="#bib0490"><span class="elsevierStyleSup">43&#44;44</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Em estudos controlados&#44; a raz&#227;o de chances para dislipidemia em pacientes com psor&#237;ase foi de 2&#44;5 &#40;95&#37; IC 1&#44;7&#8211;3&#44;3&#41;&#44; diabetes <span class="elsevierStyleItalic">mellitus</span> foi de 1&#44;8 &#40;95&#37; IC 1&#44;6&#8211;2&#44;0&#41; e hipertens&#227;o arterial sist&#234;mica de 1&#44;6 &#40;95&#37; IC 1&#44;4&#8211;1&#44;8&#41; quando comparados com pacientes saud&#225;veis&#46;<a class="elsevierStyleCrossRefs" href="#bib0475"><span class="elsevierStyleSup">40&#44;45&#8211;49</span></a> Vale ressaltar que esses elementos tamb&#233;m podem decorrer de terapias sist&#234;micas para psor&#237;ase&#44; como no caso dos retinoides&#44; que podem elevar os n&#237;veis de triglicer&#237;deos&#44; assim como aumento de peso &#233; verificado em usu&#225;rios de imunobiol&#243;gicos anti&#8208;TNF&#44; e hipertens&#227;o entre os usu&#225;rios de ciclosporina&#46;<a class="elsevierStyleCrossRefs" href="#bib0525"><span class="elsevierStyleSup">50&#44;51</span></a> Em nosso estudo&#44; foi relevante o aumento na preval&#234;ncia de dislipidemia e hipertens&#227;o nos IPso&#44; quando comparados a ISem&#44; por&#233;m tal resultado n&#227;o foi confirmado em rela&#231;&#227;o a diabetes&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">O tratamento da psor&#237;ase em pacientes idosos pode ser desafiador&#46; Na maioria das vezes&#44; essa popula&#231;&#227;o sofre de m&#250;ltiplas comorbidades e utiliza v&#225;rios medicamentos&#44; al&#233;m do progressivo comprometimento funcional do sistema imunol&#243;gico&#44; o que aumenta a suscetibilidade a infec&#231;&#245;es&#44; bem como &#224; autoreatividade e efeitos adversos &#224;s terap&#234;uticas existentes&#46; Al&#233;m disso&#44; quest&#245;es log&#237;sticas&#44; como a depend&#234;ncia de cuidadores para atividades do dia a dia&#44; podem influenciar na escolha terap&#234;utica&#46; Desse modo&#44; as terap&#234;uticas sist&#234;micas e imunobiol&#243;gicas podem ser postergadas e os t&#243;picos s&#227;o usados como primeira op&#231;&#227;o&#44; principalmente os corticoides t&#243;picos&#44; n&#227;o pela facilidade em serem administrados ao paciente&#44; mas pelo risco de poss&#237;veis eventos adversos e intera&#231;&#245;es medicamentosas que as outras terap&#234;uticas teriam&#46;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">13&#44;20</span></a> Nossos resultados corroboram essa indica&#231;&#227;o&#44; uma vez que houve maior frequ&#234;ncia de tratamento com corticoides t&#243;picos no grupo IPso &#40;100&#37;&#41; que no grupo APso &#40;86&#37;&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Ainda&#44; os corticosteroides t&#243;picos devem ser usados com cautela nessa popula&#231;&#227;o&#44; levando em considera&#231;&#227;o as altera&#231;&#245;es que ocorrem na pele envelhecida&#44; bem como o maior risco de efeitos colaterais cut&#226;neos&#44; como p&#250;rpura&#44; atrofia&#44; hematomas&#44; infec&#231;&#245;es de pele&#44; e taquifilaxia&#46;<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">37&#44;47</span></a> Importante lembrar que&#44; nos idosos&#44; as expectativas terap&#234;uticas devem ser as mesmas quando comparadas com os pacientes mais jovens&#46; Tratamentos sist&#234;micos convencionais&#44; como metotrexato e acitretina&#44; s&#227;o muitas vezes contraindicados na popula&#231;&#227;o geri&#225;trica em decorr&#234;ncia do perfil de efeitos colaterais e maiores &#237;ndices de intera&#231;&#245;es medicamentosas&#44; levando em considera&#231;&#227;o as m&#250;ltiplas comorbidades e o maior n&#250;mero de medicamentos utilizados por esses pacientes&#46; A fototerapia pode n&#227;o ser conveniente em virtude de a pele do idoso j&#225; sofrer as modifica&#231;&#245;es inerentes ao envelhecimento e&#44; desse modo&#44; ficar mais sucet&#237;vel aos poss&#237;veis efeitos colaterais&#44; como c&#226;ncer de pele ou hipersensibilidade&#46; Em rela&#231;&#227;o aos imunobiol&#243;gicos&#44; os dados preliminares quanto &#224; seguran&#231;a e efetividade s&#227;o otimistas para o uso nesse subgrupo de pacientes&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">O impacto de dermatoses cr&#244;nicas como a psor&#237;ase&#44; na sa&#250;de psicol&#243;gica e mental&#44; &#233; uma considera&#231;&#227;o importante&#44; em virtude das implica&#231;&#245;es da doen&#231;a no bem&#8208;estar do indiv&#237;duo e no tratamento&#46; Tanto o estresse psicol&#243;gico &#233; comumente considerado um gatilho e causa de piora do quadro da psor&#237;ase quanto o contingenciamento cr&#244;nico que a dermatose inflige leva ao desenvolvimento de sintomas afetivos&#46;<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">52</span></a> Pacientes com psor&#237;ase t&#234;m preval&#234;ncia aumentada de depress&#227;o e ansiedade&#44; al&#233;m de idea&#231;&#227;o suicida&#44;<a class="elsevierStyleCrossRefs" href="#bib0540"><span class="elsevierStyleSup">53&#8211;55</span></a> dado corroborado por nosso estudo&#44; que mostrou maior porcentagem de sintomas depressivos em idosos portadores da doen&#231;a quando comparados a idosos sem psor&#237;ase&#46; Ressalta&#8208;se tamb&#233;m a alta preval&#234;ncia de sintomas depressivos identificada em adultos portadores de psor&#237;ase&#46; Deve&#8208;se&#44; pois&#44; atentar para a identifica&#231;&#227;o e o tratamento das comorbidades psiqui&#225;tricas nesses pacientes&#44; al&#233;m de que transtornos mentais podem ser um fator para a n&#227;o ades&#227;o ao tratamento&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Fragilidade &#233; definida como s&#237;ndrome de decl&#237;nio de energia em idosos&#44; fundamentada em altera&#231;&#245;es intr&#237;nsecas ao envelhecimento&#44; como sarcopenia e disfun&#231;&#227;o imunol&#243;gica&#44; e extr&#237;nsecas&#44; como doen&#231;as&#44; imobilidade e diminui&#231;&#227;o da energia&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">22</span></a> O idoso fr&#225;gil tem comprometida sua capacidade di&#225;ria em lidar com estresses agudos&#44; tornando&#8208;se mais dependente e suscet&#237;vel a agressores&#46; A fragilidade &#233; manifestada por fadiga&#44; diminui&#231;&#227;o da velocidade na marcha e for&#231;a de preens&#227;o&#44; perda ponderal e baixo n&#237;vel de atividade f&#237;sica&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">22</span></a> Avaliamos esses indicadores e identificamos maiores &#237;ndices de fadiga no grupo de IPso em compara&#231;&#227;o aos ISem&#44; corroborando que a psor&#237;ase seria fator adicional de fragilidade aos idosos portadores da doen&#231;a&#44; assim como a presen&#231;a de artrite tamb&#233;m adiciona fragilidade aos idosos portadores dessa condi&#231;&#227;o&#44; limitando sua funcionalidade&#44; j&#225; que nossos pacientes geri&#225;tricos com artrite apresentaram menor for&#231;a de preens&#227;o durante as avalia&#231;&#245;es&#46; Da mesma maneira&#44; os escores de depress&#227;o se associaram &#224; fragilidade e diminui&#231;&#227;o do comprometimento funcional dos pacientes&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Este estudo apresenta naturais limita&#231;&#245;es ligadas &#224; popula&#231;&#227;o de institui&#231;&#227;o p&#250;blica&#44; de um &#250;nico centro&#44; e pacientes sob tratamento em servi&#231;o secund&#225;rio&#44; o que&#44; por outro lado&#44; garantiu certa homogeneidade da amostra&#44; e n&#227;o impediu a explora&#231;&#227;o de fatores entre os grupos&#46; Os &#237;ndices de gravidade s&#227;o de dif&#237;cil caracteriza&#231;&#227;o&#44; j&#225; que todos os pacientes estavam sob tratamento&#46; Fazem&#8208;se necess&#225;rios estudos de caracteriza&#231;&#227;o dessa faixa et&#225;ria&#44; j&#225; que o aumento da preval&#234;ncia das doen&#231;as cr&#244;nicas&#44; dentre elas a psor&#237;ase&#44; vem acompanhando o aumento da expectativa de vida da popula&#231;&#227;o geral&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#227;o</span><p id="par0160" class="elsevierStylePara elsevierViewall">N&#227;o houve diferen&#231;a entre apresenta&#231;&#227;o cl&#237;nica&#44; acometimento ungueal&#44; de couro cabeludo ou presen&#231;a de artrite entre o grupo de idosos e adultos portadores de psor&#237;ase avaliados&#46; Os idosos&#44; atendidos em centro de refer&#234;ncia apresentaram maiores &#237;ndices de sintomas depressivos&#44; comorbidades metab&#243;licas e fragilidade f&#237;sica em compara&#231;&#227;o aos controles idosos saud&#225;veis&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Suporte financeiro</span><p id="par0165" class="elsevierStylePara elsevierViewall">FAPESP &#40;projeto n&#176; 19&#47;06684&#8208;5&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Contribui&#231;&#227;o dos autores</span><p id="par0170" class="elsevierStylePara elsevierViewall">Giovana Viotto Cagnon Brand&#227;o&#58; Concep&#231;&#227;o do estudo&#59; coleta dos dados&#59; escrita do texto&#59; revis&#227;o e aprova&#231;&#227;o do texto final&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Elizandra Gomes Pereira&#58; Coleta dos dados&#59; escrita do texto&#59; revis&#227;o e aprova&#231;&#227;o do texto final&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Gabriela Roncada Haddad&#58; Coleta dos dados&#59; escrita do texto&#59; revis&#227;o e aprova&#231;&#227;o do texto final&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Luciane Donida Bartoli Miot&#58; Concep&#231;&#227;o do estudo&#59; revis&#227;o e aprova&#231;&#227;o do texto final&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Silvio Alencar Marques&#58; Revis&#227;o e aprova&#231;&#227;o do texto final&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">H&#233;lio Amante Miot&#58; Concep&#231;&#227;o do estudo&#59; an&#225;lise dos resultados&#59; escrita do texto&#59; revis&#227;o e aprova&#231;&#227;o do texto final&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflito de interesses</span><p id="par0200" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">H&#225; poucos estudos dedicados &#224; caracteriza&#231;&#227;o da popula&#231;&#227;o geri&#225;trica com psor&#237;ase&#44; que apresenta particularidades quanto &#224;s manifesta&#231;&#245;es cl&#237;nicas e limita&#231;&#245;es terap&#234;uticas&#46; Como a psor&#237;ase tem comportamento de doen&#231;a cr&#244;nica&#44; aumentando sua preval&#234;ncia com a idade&#44; o incremento da expectativa de vida no Brasil demanda conhecimento sobre o comportamento da doen&#231;a entre idosos&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Caracterizar idosos com psor&#237;ase&#44; oriundos de servi&#231;o terci&#225;rio&#44; do ponto de vista cl&#237;nico&#8208;epidemiol&#243;gico&#44; presen&#231;a de comorbidades&#44; fragilidade f&#237;sica e o impacto afetivo&#46; Comparar esses aspectos com adultos com psor&#237;ase e idosos sem a doen&#231;a&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudo transversal com 64 pacientes idosos com psor&#237;ase&#44; 64 adultos com psor&#237;ase&#44; e 64 idosos sem a doen&#231;a&#46; Foram avaliados aspectos cl&#237;nico&#8208;demogr&#225;ficos&#44; escala de depress&#227;o de Beck e Skindex&#8208;16&#46; Nos pacientes idosos&#44; foram avaliados indicadores de fragilidade f&#237;sica&#58; <span class="elsevierStyleItalic">handgrip</span>&#44; teste da cadeira&#44; fadiga e perda ponderal &#62;<span class="elsevierStyleHsp" style=""></span>5&#37;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Nos idosos&#44; a idade m&#233;dia &#40;DP&#41; do in&#237;cio da psor&#237;ase foi 44 &#40;10&#41; anos&#59; homens representaram 47&#37; da amostra&#59; a preval&#234;ncia de artrite foi 22&#37;&#44; e de acometimento ungueal&#44; 72&#37;&#46; Corticoide t&#243;pico foi mais empregado entre idosos com psor&#237;ase &#40;100&#37;&#41; que nos adultos &#40;86&#37;&#41;&#44; sem diferen&#231;a entre os demais tratamentos sist&#234;micos&#46; Diabetes <span class="elsevierStyleItalic">mellitus</span> ocorreu em 30&#37; dos idosos&#46; Hipertens&#227;o arterial &#40;59&#37;&#41;&#44; dislipidemia &#40;52&#37;&#41;&#44; depress&#227;o &#40;34&#37;&#41; e fadiga &#40;59&#37;&#41; foram mais prevalentes entre idosos com psor&#237;ase que entre idosos saud&#225;veis&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Estudo realizado em servi&#231;o p&#250;blico de refer&#234;ncia para psor&#237;ase&#59; todos estavam sob tratamento&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#245;es</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Idosos com psor&#237;ase&#44; oriundos de servi&#231;o terci&#225;rio&#44; apresentaram maior comprometimento afetivo&#44; comorbidades metab&#243;licas e fragilidade f&#237;sica do que os controles idosos&#46;</p></span>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fundamental&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Skindex&#8208;16</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sintomas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Emocional&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Funcional&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;0&#8211;40&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Palmoplantar&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Ungueal&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Onic&#243;lise&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pittings&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Traquion&#237;quia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Artrite&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#227;os&#47;punhos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Joelhos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamento&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CTC t&#243;pico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">55 &#40;86&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Calcipotriol&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;842&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Metotrexato&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">30 &#40;47&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">37 &#40;58&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;288&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Acitretina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24 &#40;34&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;110&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">&#205;ndices de fragilidade f&#237;sica em idosos</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Handgrip</span> em kg&#44; mediana &#40;P25&#8211;P75&#41;&nbsp;\t\t\t\t\t\t\n
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Caracterização clínica, fragilidade física e depressão em idosos com psoríase oriundos de centro de referência no Brasil: estudo transversal
Giovana Viotto Cagnon Brandão, Elizandra Gomes Pereira, Gabriela Roncada Haddad, Luciane Donida Bartoli Miot, Silvio Alencar Marques, Hélio Amante Miot
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Departamento de Infectologia, Dermatologia, Diagnóstico por Imagem e Radioterapia, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brasil
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">Psor&#237;ase &#233; doen&#231;a inflamat&#243;ria cr&#244;nica sist&#234;mica&#44; imunomediada por linf&#243;citos&#8208;T &#40;resposta Th1 e Th17&#41;&#44; que apresenta car&#225;ter multifatorial envolvendo suscetibilidade gen&#233;tica &#40;polig&#234;nica&#41;&#44; associada a fatores ambientais&#44; como trauma&#44; medicamentos&#44; infec&#231;&#245;es e fatores emocionais&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A pele &#233; o principal &#243;rg&#227;o afetado pela psor&#237;ase&#44; apesar de poder acometer articula&#231;&#245;es&#44; mucosas e unhas e estar associada a outras condi&#231;&#245;es sist&#234;micas&#44; como doen&#231;a de Crohn&#44; uve&#237;te&#44; altera&#231;&#245;es psiqui&#225;tricas e esteatose hep&#225;tica n&#227;o alco&#243;lica&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">3&#44;4</span></a> Os pacientes com psor&#237;ase&#44; de todas as faixas et&#225;rias&#44; apresentam maior preval&#234;ncia de s&#237;ndrome metab&#243;lica&#44; caracterizada por obesidade&#44; hipertens&#227;o arterial sist&#234;mica&#44; diabetes <span class="elsevierStyleItalic">mellitus</span> tipo II&#44; dislipidemia e aumento do risco de desenvolvimento de doen&#231;as cardiovasculares&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">5&#8211;7</span></a> Em virtude do impacto na qualidade de vida e da indu&#231;&#227;o de inflama&#231;&#227;o sist&#234;mica &#40;via TNF&#945;&#44; IL&#8208;6 e IL&#8208;1&#41;&#44; a psor&#237;ase &#233; associada a dist&#250;rbios afetivos&#44; e cerca de 30&#37; dos pacientes apresentam alguma comorbidade psiqui&#225;trica &#40;p&#46; ex&#46;&#44; depress&#227;o e transtorno de ansiedade&#41; que compromete a produtividade laboral e o relacionamento interpessoal e eleva o risco de suic&#237;dio&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">8&#8211;11</span></a> No Brasil&#44; a preval&#234;ncia de psor&#237;ase &#233; estimada entre 1&#44;10&#37; e 1&#44;51&#37;&#59; entretanto&#44; em idosos&#44; essa estimativa se eleva para 1&#44;71&#37; a 2&#44;84&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">12</span></a> O aumento da expectativa de vida da popula&#231;&#227;o alude ao crescimento na preval&#234;ncia de doen&#231;as cr&#244;nicas na popula&#231;&#227;o&#44; e entre elas&#44; a psor&#237;ase&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Considera&#231;&#245;es especiais devem ser feitas acerca da assist&#234;ncia &#224; popula&#231;&#227;o geri&#225;trica&#44; que tende a apresentar m&#250;ltiplas comorbidades e utilizar diversos medicamentos concomitantemente&#44; maximizando efeitos adversos e intera&#231;&#245;es medicamentosas&#46; Com o avan&#231;o da idade&#44; h&#225; modifica&#231;&#245;es metab&#243;licas e dos sistemas antioxidantes&#44; o que altera processos farmacodin&#226;micos e farmacocin&#233;ticos&#46; Al&#233;m disso&#44; a imunossenesc&#234;ncia favorece quadro inflamat&#243;rio cr&#244;nico que compromete funcionalmente a imunidade&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">13</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">H&#225; poucos estudos sistem&#225;ticos da psor&#237;ase no idoso&#44; assim como de suas particularidades cl&#237;nicas&#44; terap&#234;uticas e seu impacto na fragilidade f&#237;sica&#46;<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">14&#44;15</span></a> No Brasil&#44; de acordo com a Lei 10&#46;471&#47;033 que delibera sobre o Estatuto da Pessoa Idosa&#44; s&#227;o considerados idosos os indiv&#237;duos com idade igual ou superior a 60 anos&#46; Frequentemente&#44; idosos s&#227;o exclu&#237;dos dos ensaios cl&#237;nicos&#44; por serem considerados grupo de risco para eventos adversos aos tratamentos&#46;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">13&#44;16&#8211;18</span></a> Tamb&#233;m s&#227;o escassos os dados quanto &#224; efic&#225;cia e seguran&#231;a de medicamentos sist&#234;micos e imunobiol&#243;gicos nessa faixa et&#225;ria&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">19</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Este estudo objetivou caracterizar vari&#225;veis cl&#237;nico&#8208;demogr&#225;ficas&#44; presen&#231;a de comorbidades&#44; fragilidade f&#237;sica e o impacto afetivo em idosos portadores de psor&#237;ase atendidos em servi&#231;o de dermatologia de refer&#234;ncia&#44; assim como comparar esses aspectos com adultos com psor&#237;ase e idosos sem a doen&#231;a&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Casu&#237;stica e m&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Conduziu&#8208;se estudo transversal &#40;utilizando duas popula&#231;&#245;es de controle&#41; envolvendo 64 pacientes com psor&#237;ase maiores que 60 anos de idade&#44; 64 pacientes com psor&#237;ase com menos de 50 anos de idade e 64 idosos sem psor&#237;ase&#46; O estudo foi conduzido no ambulat&#243;rio de dermatologia da Universidade Estadual Paulista&#44; entre mar&#231;o de 2019 e mar&#231;o de 2021&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A amostragem aconteceu por conveni&#234;ncia&#44; e foram inclu&#237;dos casos e controles eleg&#237;veis&#44; consecutivamente&#44; durante os atendimentos m&#233;dicos&#46; Pacientes com psor&#237;ase &#40;idosos e adultos&#41; eram oriundos do ambulat&#243;rio de psor&#237;ase do servi&#231;o&#46; Os controles idosos eram portadores de outras doen&#231;as dermatol&#243;gicas localizadas que frequentavam o ambulat&#243;rio de Dermatologia ou eram acompanhantes dos pacientes&#46; N&#227;o foram inclu&#237;dos no estudo indiv&#237;duos com dificuldade de compreens&#227;o ou interpreta&#231;&#227;o&#44; pacientes sem les&#245;es cl&#237;nicas de psor&#237;ase ao exame e portadores de outras dermatoses extensas&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">O projeto foi aprovado pelo Comit&#234; de &#201;tica em Pesquisa da institui&#231;&#227;o &#40;FMB&#8208;Unesp n&#176; 3&#46;318&#46;242&#41;&#44; e todos os participantes assinaram o termo de consentimento esclarecido&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Idosos com psor&#237;ase &#40;IPso&#41;&#44; idosos sem psor&#237;ase &#40;ISem&#41; e adultos com psor&#237;ase &#40;APso&#41; foram caracterizados quanto aspectos demogr&#225;ficos&#44; antropom&#233;tricos&#44; tratamento atual&#44; tabagismo&#44; consumo de &#225;lcool&#44; escala de depress&#227;o de Beck e as principais comorbidades&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">20</span></a> Idosos &#40;IPso e ISem&#41; foram avaliados quanto &#224; fragilidade f&#237;sica pelo teste da cadeira&#44; for&#231;a de preens&#227;o manual &#40;<span class="elsevierStyleItalic">handgrip</span>&#41;&#44; perda ponderal e fadiga&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">21</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">A escala de Beck para autoavalia&#231;&#227;o da depress&#227;o &#233; composta por 21 itens que abrangem os componentes cognitivos&#44; afetivos&#44; comportamentais e som&#225;ticos da depress&#227;o&#46; Cada item cont&#233;m quatro afirma&#231;&#245;es que variam quanto &#224; intensidade &#40;0 a 3&#41;&#44; cabendo ao questionado indicar qual das quatro afirma&#231;&#245;es mais bem descreve seus sintomas&#46; O escore final &#233; obtido mediante o somat&#243;rio dos 21 itens que comp&#245;em a escala&#44; resultando na seguinte normatiza&#231;&#227;o&#58; a&#41; nenhuma depress&#227;o ou depress&#227;o m&#237;nima&#58; escores finais &#60;<span class="elsevierStyleHsp" style=""></span>11 pontos&#59; b&#41; depress&#227;o leve a moderada&#58; escores finais entre 12 a 19 pontos&#59; c&#41; depress&#227;o moderada a grave&#58; escores finais entre 20 a 35 pontos&#59; e d&#41; depress&#227;o grave&#58; escores finais entre 36 a 63 pontos&#46;<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">22&#44;23</span></a> A escala de Beck &#233; um dos instrumentos mais utilizados para a avalia&#231;&#227;o do transtorno depressivo e suas vari&#225;veis&#44; aplicada em pacientes psiqui&#225;tricos e n&#227;o psiqui&#225;tricos&#44; validada em outros pa&#237;ses e confirmada quanto aos crit&#233;rios de confiabilidade e validade&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">O teste da cadeira fornece avalia&#231;&#227;o indireta do desempenho f&#237;sico dos pacientes&#44; que foram orientados a levantar&#8208;se e sentar&#8208;se de uma cadeira de altura normal &#40;aproximadamente 48<span class="elsevierStyleHsp" style=""></span>cm&#41; cinco vezes consecutivas&#44; sem apoio das m&#227;os&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">24</span></a> A for&#231;a de preens&#227;o manual&#44; crit&#233;rio indireto de for&#231;a muscular&#44; foi mensurada por <span class="elsevierStyleItalic">handgrip</span>&#44; por meio de um dinam&#244;metro manual &#40;<span class="elsevierStyleItalic">hand dynamometer</span> DRP&#8208;120&#41;&#44; na m&#227;o dominante de cada paciente&#44; e foi considerada a maior medida &#40;em kg&#41; dentre tr&#234;s tentativas realizadas&#46; Perda ponderal foi caracterizada pela redu&#231;&#227;o de mais que 5&#37; do seu peso nos &#250;ltimos tr&#234;s anos&#46; A avali&#231;&#227;o da fadiga&#44; segundo o Consenso Brasileiro de Fragilidade em Idosos&#44; foi realizada por meio do questionamento direto para o paciente se o mesmo se sentia &#8220;cheio de energia&#8221; naquele exato momento&#46;<a class="elsevierStyleCrossRefs" href="#bib0400"><span class="elsevierStyleSup">25&#44;26</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Os pacientes com psor&#237;ase foram submetidos &#224; avalia&#231;&#227;o cl&#237;nica pelo escore PASI &#40;Psoriasis Area Severity Index&#41;&#44; escore BSA &#40;Body Surface Area&#41;&#44; escore PGA &#40;Physician Global Assessment&#41; para o couro cabeludo e corpo&#44; avaliados por dermatologista titulado&#44; al&#233;m do question&#225;rio de qualidade de vida Skindex&#8208;16&#44; validado para o portugu&#234;s do Brasil&#46;<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">27&#8211;29</span></a> A consist&#234;ncia interna das escalas de Beck e das dimens&#245;es do Skindex&#8208;16 foram avaliadas pelo coeficiente McDonald&#39;s &#969;&#44; e seu intervalo de confian&#231;a de 95&#37; &#40;95&#37; IC&#41;&#46; Vari&#225;veis quantitativas e ordinais foram descritas como percentuais&#44; e comparadas pelo teste do Qui&#8208;quadrado de tend&#234;ncia e an&#225;lise dos res&#237;duos da tabela de conting&#234;ncia &#40;<span class="elsevierStyleItalic">post hoc</span>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">30</span></a> Vari&#225;veis quantitativas foram descritas como m&#233;dia e desvio&#8208;padr&#227;o ou mediana e quartis &#40;p25&#8211;p75&#41;&#44; se a normalidade n&#227;o fosse verificada pelo teste de Shapiro&#8208;Wilk&#46;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">31</span></a> As correla&#231;&#245;es entre vari&#225;veis quantitativas foram avaliadas pelo coeficiente rho de Spearman&#46;<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">32</span></a> Os grupos foram comparados entre si por modelos de regress&#227;o &#40;log&#8208;linear&#41; de Poisson&#44; e a dimens&#227;o do efeito foi expressa pela raz&#227;o de preval&#234;ncia &#40;RP&#41; e seu 95&#37; IC&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">33</span></a> Dados foram tabulados em MS Excel 2010 e analisados pelo <span class="elsevierStyleItalic">software</span> IBM SPSS 25&#46; Considerou&#8208;se significante p&#8208;valor &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">34</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">A amostra foi dimensionada a partir de um pr&#233;&#8208;teste com 64 participantes em cada grupo de idosos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>128&#41;&#44; com base na estimativa para a regress&#227;o &#40;log&#8208;linear&#41; de Poisson para a compara&#231;&#227;o entre as vari&#225;veis de fragilidade f&#237;sica&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">35</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0070" class="elsevierStylePara elsevierViewall">Os principais dados demogr&#225;ficos dos participantes do estudo est&#227;o dispostos na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46; Destacam&#8208;se o grupo ISem com maior renda familiar&#59; j&#225; o grupo APso apresentou maior escolaridade&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Quanto ao aspecto cl&#237;nico e terap&#234;utico da psor&#237;ase &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#44; os grupos IPso e APso apresentaram par&#226;metros cl&#237;nicos compar&#225;veis&#44; por&#233;m&#44; diferiram quanto &#224; idade de in&#237;cio da doen&#231;a e quanto ao uso de corticoterapia t&#243;pica&#46; As classes de imunobiol&#243;gicos utilizadas pelos IPso foram anti&#8208;TNF alfa &#40;etanercepte&#44; infliximabe e adalimumabe&#41; e anti IL&#8208;17A &#40;secuquinumabe&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Entre os IPso&#44; cinco pacientes &#40;7&#44;8&#37;&#59; 95&#37; IC 1&#44;6&#8211;15&#44;0&#41; apresentaram o in&#237;cio da doen&#231;a ap&#243;s os 60 anos de idade&#46; Quando ajustado pela idade atual e sexo&#44; os pacientes IPso com in&#237;cio da doen&#231;a na terceira idade n&#227;o apresentaram gravidade cl&#237;nica&#44; fragilidade f&#237;sica&#44; frequ&#234;ncia de comorbidades ou comprometimento afetivo que diferissem dos IPso com in&#237;cio da doen&#231;a antes dos 60 anos de idade &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;1&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">O invent&#225;rio Skindex&#8208;16 apresentou adequada consist&#234;ncia interna &#40;McDonald&#39;s &#969;&#41; &#62;<span class="elsevierStyleHsp" style=""></span>0&#44;82&#44; para as tr&#234;s dimens&#245;es&#44; n&#227;o havendo diferen&#231;a dos escores entre os grupos&#46; A dimens&#227;o funcional foi a mais correlata com o escore de Beck &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;471&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#59; por&#233;m&#44; n&#227;o se associou &#224; presen&#231;a de artrite &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;131&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">A <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a> apresenta a compara&#231;&#227;o dos principais elementos cl&#237;nico&#8208;demogr&#225;ficos&#44; aspectos afetivos e &#237;ndices de fragilidade entre os grupos&#46; Houve aumento na preval&#234;ncia de comorbidades entre IPso e APso&#44; como hipertens&#227;o&#44; dislipidemia e diabetes&#46; J&#225; quando comparado IPso com ISem&#44; al&#233;m de mais comorbidades ligadas &#224; s&#237;ndrome metab&#243;lica&#44; como hipertens&#227;o arterial sist&#234;mica e dislipidemia&#44; houve maior preval&#234;ncia de fadiga e depress&#227;o&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">A escala de Beck apresentou alta consist&#234;ncia interna&#59; o coeficiente McDonald&#39;s &#969; resultou 0&#44;86 &#40;95&#37; IC 0&#44;83&#8211;0&#44;89&#41;&#46; Os itens B1 &#40;sentimento de tristeza&#41; e B15 &#40;capacidade de trabalhar&#41; foram proeminentes &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; na diferen&#231;a entre IPso e ISem&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Em pacientes com psor&#237;ase&#44; os portadores de artrite apresentaram menor for&#231;a m&#233;dia de preens&#227;o &#40;5&#44;1 <span class="elsevierStyleItalic">vs</span>&#46; 10&#44;0<span class="elsevierStyleHsp" style=""></span>kg&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;030&#41;&#44; por&#233;m artrite n&#227;o foi determinante do desempenho no teste da cadeira ou de fadiga &#40;p &#62;<span class="elsevierStyleHsp" style=""></span>0&#44;760&#41;&#46; Quanto aos escores de Beck&#44; eles foram mais elevados para os idosos que referiam fadiga e perda ponderal &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0105" class="elsevierStylePara elsevierViewall">Nesta amostra brasileira de pacientes atendidos em centro de refer&#234;ncia&#44; idosos com psor&#237;ase apresentaram idade m&#233;dia de in&#237;cio da psor&#237;ase ap&#243;s a quarta d&#233;cada&#44; n&#227;o houve prefer&#234;ncia por sexo e as caracter&#237;sticas cl&#237;nicas&#44; al&#233;m do impacto na qualidade de vida&#44; n&#227;o diferiram dos adultos com psor&#237;ase atendidos no mesmo ambulat&#243;rio&#46; Apesar disso&#44; apresentaram maior preval&#234;ncia de sintomas depressivos&#44; elementos de fragilidade f&#237;sica e par&#226;metros de s&#237;ndrome metab&#243;lica que idosos sem psor&#237;ase&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Cerca de 10&#37; dos casos de psor&#237;ase atendidos na pr&#225;tica dermatol&#243;gica s&#227;o pacientes idosos&#59; no entanto&#44; essa preval&#234;ncia vem crescendo e espera&#8208;se que aumente com o envelhecimento da popula&#231;&#227;o&#46;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">13&#44;36</span></a> Al&#233;m da longevidade&#44; o acesso da popula&#231;&#227;o &#224; informa&#231;&#227;o sobre a doen&#231;a e ao sistema de sa&#250;de para confirma&#231;&#227;o do diagn&#243;stico s&#227;o fatores que podem implicar no aumento da incid&#234;ncia de psor&#237;ase como um todo nas &#250;ltimas d&#233;cadas&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Entre os pacientes idosos com psor&#237;ase&#44; podemos dividi&#8208;los entre os que tiveram o in&#237;cio da doen&#231;a durante a senesc&#234;ncia &#40;ap&#243;s 60 anos de idade&#41;&#44; que corresponde a 3&#37; a 13&#37; dos casos&#44; e os que a iniciaram mais precocemente &#40;antes dos 60 anos&#41;&#46; Espera&#8208;se que a psor&#237;ase de in&#237;cio ap&#243;s os 60 anos tenha quadro cl&#237;nico mais brando&#44; com menores &#237;ndices de BSA&#44; acometimento ungueal e articular&#44; em compara&#231;&#227;o aos pacientes com in&#237;cio mais precoce&#46; No entanto&#44; s&#227;o raros os estudos dedicados a sua caracteriza&#231;&#227;o&#44; j&#225; que a representa&#231;&#227;o da popula&#231;&#227;o geri&#225;trica nos ensaios cl&#237;nicos ainda &#233; escassa&#46;<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">37&#44;38</span></a> Apenas 15&#37; dessa popula&#231;&#227;o desenvolve psor&#237;ase moderada a grave e necessita de tratamentos sist&#234;micos&#46; Em nossa amostra&#44; n&#227;o observamos diferen&#231;a entre a distribui&#231;&#227;o de PASI&#44; BSA&#44; PGA corpo&#47;couro cabeludo&#44; acometimento palmoplantar ou ungueal e atrite entre os dois grupos de pacientes portadores de psor&#237;ase &#40;IPso e APso&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Em amostra de 156 iranianos idosos com psor&#237;ase&#44; foram avaliadas caracter&#237;sticas demogr&#225;ficas&#44; comorbidades&#44; idade de in&#237;cio da doen&#231;a&#44; forma cl&#237;nica predominante&#44; gravidade e abordagens terap&#234;uticas&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">36</span></a> A caracter&#237;stica cl&#237;nica mais comum da doen&#231;a foi o tipo placa &#40;73&#44;1&#37;&#41;&#44; seguida pelo tipo pustulosa &#40;10&#44;9&#37;&#41;&#44; e o local mais frequentemente envolvido foram as extremidades &#40;84&#44;6&#37;&#41;&#46; Couro cabeludo&#44; unhas e articula&#231;&#245;es foram envolvidos em 26&#44;9&#37;&#44; 40&#44;3&#37; e 19&#44;2&#37; dos pacientes avaliados&#44; respectivamente&#46; A pontua&#231;&#227;o m&#233;dia do PASI encontrada foi de 5&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;5&#46; Hipertens&#227;o &#40;25&#37;&#41; e diabetes <span class="elsevierStyleItalic">mellitus</span> &#40;16&#37;&#41; foram as doen&#231;as mais prevalentes&#46; Em rela&#231;&#227;o &#224; abordagem terap&#234;utica dos pacientes&#44; a maioria foi tratada topicamente &#40;81&#44;7&#37;&#41;&#44; e dentre os tratamentos sist&#234;micos&#44; o metotrexato e a acitretina foram os mais frequentes&#44; respons&#225;veis por 74&#44;4&#37; e 60&#44;3&#37; dos pacientes&#46; Os homens apresentaram menor m&#233;dia de idade de in&#237;cio da doen&#231;a &#40;51&#44;8 anos&#41; em compara&#231;&#227;o com as mulheres &#40;59&#44;2 anos&#41;&#46; Pacientes com envolvimento articular apresentaram menor m&#233;dia de idade &#40;65&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;3 anos&#41; quando comparados &#224;queles sem esse envolvimento &#40;69&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;4 anos&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">39</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Idade &#233; fator de risco adicional para hipertens&#227;o&#44; dislipidemia&#44; depress&#227;o e diabetes tipo 2&#46; Em nossa amostra de idosos com psor&#237;ase&#44; esses par&#226;metros foram mais prevalentes que nos controles idosos&#46; De fato&#44; quando comparados a controles saud&#225;veis&#44; os portadores de psor&#237;ase apresentam aumento da preval&#234;ncia de dislipidemia&#44; hipertens&#227;o&#44; doen&#231;a arterial coronariana&#44; diabetes tipo 2 e aumento do &#237;ndice de massa corporal &#40;IMC&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0450"><span class="elsevierStyleSup">35&#44;40&#8211;42</span></a> Esses elementos podem corroborar para maior mortalidade cardiovascular entre portadores de psor&#237;ase&#46;<a class="elsevierStyleCrossRefs" href="#bib0490"><span class="elsevierStyleSup">43&#44;44</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Em estudos controlados&#44; a raz&#227;o de chances para dislipidemia em pacientes com psor&#237;ase foi de 2&#44;5 &#40;95&#37; IC 1&#44;7&#8211;3&#44;3&#41;&#44; diabetes <span class="elsevierStyleItalic">mellitus</span> foi de 1&#44;8 &#40;95&#37; IC 1&#44;6&#8211;2&#44;0&#41; e hipertens&#227;o arterial sist&#234;mica de 1&#44;6 &#40;95&#37; IC 1&#44;4&#8211;1&#44;8&#41; quando comparados com pacientes saud&#225;veis&#46;<a class="elsevierStyleCrossRefs" href="#bib0475"><span class="elsevierStyleSup">40&#44;45&#8211;49</span></a> Vale ressaltar que esses elementos tamb&#233;m podem decorrer de terapias sist&#234;micas para psor&#237;ase&#44; como no caso dos retinoides&#44; que podem elevar os n&#237;veis de triglicer&#237;deos&#44; assim como aumento de peso &#233; verificado em usu&#225;rios de imunobiol&#243;gicos anti&#8208;TNF&#44; e hipertens&#227;o entre os usu&#225;rios de ciclosporina&#46;<a class="elsevierStyleCrossRefs" href="#bib0525"><span class="elsevierStyleSup">50&#44;51</span></a> Em nosso estudo&#44; foi relevante o aumento na preval&#234;ncia de dislipidemia e hipertens&#227;o nos IPso&#44; quando comparados a ISem&#44; por&#233;m tal resultado n&#227;o foi confirmado em rela&#231;&#227;o a diabetes&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">O tratamento da psor&#237;ase em pacientes idosos pode ser desafiador&#46; Na maioria das vezes&#44; essa popula&#231;&#227;o sofre de m&#250;ltiplas comorbidades e utiliza v&#225;rios medicamentos&#44; al&#233;m do progressivo comprometimento funcional do sistema imunol&#243;gico&#44; o que aumenta a suscetibilidade a infec&#231;&#245;es&#44; bem como &#224; autoreatividade e efeitos adversos &#224;s terap&#234;uticas existentes&#46; Al&#233;m disso&#44; quest&#245;es log&#237;sticas&#44; como a depend&#234;ncia de cuidadores para atividades do dia a dia&#44; podem influenciar na escolha terap&#234;utica&#46; Desse modo&#44; as terap&#234;uticas sist&#234;micas e imunobiol&#243;gicas podem ser postergadas e os t&#243;picos s&#227;o usados como primeira op&#231;&#227;o&#44; principalmente os corticoides t&#243;picos&#44; n&#227;o pela facilidade em serem administrados ao paciente&#44; mas pelo risco de poss&#237;veis eventos adversos e intera&#231;&#245;es medicamentosas que as outras terap&#234;uticas teriam&#46;<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">13&#44;20</span></a> Nossos resultados corroboram essa indica&#231;&#227;o&#44; uma vez que houve maior frequ&#234;ncia de tratamento com corticoides t&#243;picos no grupo IPso &#40;100&#37;&#41; que no grupo APso &#40;86&#37;&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Ainda&#44; os corticosteroides t&#243;picos devem ser usados com cautela nessa popula&#231;&#227;o&#44; levando em considera&#231;&#227;o as altera&#231;&#245;es que ocorrem na pele envelhecida&#44; bem como o maior risco de efeitos colaterais cut&#226;neos&#44; como p&#250;rpura&#44; atrofia&#44; hematomas&#44; infec&#231;&#245;es de pele&#44; e taquifilaxia&#46;<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">37&#44;47</span></a> Importante lembrar que&#44; nos idosos&#44; as expectativas terap&#234;uticas devem ser as mesmas quando comparadas com os pacientes mais jovens&#46; Tratamentos sist&#234;micos convencionais&#44; como metotrexato e acitretina&#44; s&#227;o muitas vezes contraindicados na popula&#231;&#227;o geri&#225;trica em decorr&#234;ncia do perfil de efeitos colaterais e maiores &#237;ndices de intera&#231;&#245;es medicamentosas&#44; levando em considera&#231;&#227;o as m&#250;ltiplas comorbidades e o maior n&#250;mero de medicamentos utilizados por esses pacientes&#46; A fototerapia pode n&#227;o ser conveniente em virtude de a pele do idoso j&#225; sofrer as modifica&#231;&#245;es inerentes ao envelhecimento e&#44; desse modo&#44; ficar mais sucet&#237;vel aos poss&#237;veis efeitos colaterais&#44; como c&#226;ncer de pele ou hipersensibilidade&#46; Em rela&#231;&#227;o aos imunobiol&#243;gicos&#44; os dados preliminares quanto &#224; seguran&#231;a e efetividade s&#227;o otimistas para o uso nesse subgrupo de pacientes&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">O impacto de dermatoses cr&#244;nicas como a psor&#237;ase&#44; na sa&#250;de psicol&#243;gica e mental&#44; &#233; uma considera&#231;&#227;o importante&#44; em virtude das implica&#231;&#245;es da doen&#231;a no bem&#8208;estar do indiv&#237;duo e no tratamento&#46; Tanto o estresse psicol&#243;gico &#233; comumente considerado um gatilho e causa de piora do quadro da psor&#237;ase quanto o contingenciamento cr&#244;nico que a dermatose inflige leva ao desenvolvimento de sintomas afetivos&#46;<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">52</span></a> Pacientes com psor&#237;ase t&#234;m preval&#234;ncia aumentada de depress&#227;o e ansiedade&#44; al&#233;m de idea&#231;&#227;o suicida&#44;<a class="elsevierStyleCrossRefs" href="#bib0540"><span class="elsevierStyleSup">53&#8211;55</span></a> dado corroborado por nosso estudo&#44; que mostrou maior porcentagem de sintomas depressivos em idosos portadores da doen&#231;a quando comparados a idosos sem psor&#237;ase&#46; Ressalta&#8208;se tamb&#233;m a alta preval&#234;ncia de sintomas depressivos identificada em adultos portadores de psor&#237;ase&#46; Deve&#8208;se&#44; pois&#44; atentar para a identifica&#231;&#227;o e o tratamento das comorbidades psiqui&#225;tricas nesses pacientes&#44; al&#233;m de que transtornos mentais podem ser um fator para a n&#227;o ades&#227;o ao tratamento&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Fragilidade &#233; definida como s&#237;ndrome de decl&#237;nio de energia em idosos&#44; fundamentada em altera&#231;&#245;es intr&#237;nsecas ao envelhecimento&#44; como sarcopenia e disfun&#231;&#227;o imunol&#243;gica&#44; e extr&#237;nsecas&#44; como doen&#231;as&#44; imobilidade e diminui&#231;&#227;o da energia&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">22</span></a> O idoso fr&#225;gil tem comprometida sua capacidade di&#225;ria em lidar com estresses agudos&#44; tornando&#8208;se mais dependente e suscet&#237;vel a agressores&#46; A fragilidade &#233; manifestada por fadiga&#44; diminui&#231;&#227;o da velocidade na marcha e for&#231;a de preens&#227;o&#44; perda ponderal e baixo n&#237;vel de atividade f&#237;sica&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">22</span></a> Avaliamos esses indicadores e identificamos maiores &#237;ndices de fadiga no grupo de IPso em compara&#231;&#227;o aos ISem&#44; corroborando que a psor&#237;ase seria fator adicional de fragilidade aos idosos portadores da doen&#231;a&#44; assim como a presen&#231;a de artrite tamb&#233;m adiciona fragilidade aos idosos portadores dessa condi&#231;&#227;o&#44; limitando sua funcionalidade&#44; j&#225; que nossos pacientes geri&#225;tricos com artrite apresentaram menor for&#231;a de preens&#227;o durante as avalia&#231;&#245;es&#46; Da mesma maneira&#44; os escores de depress&#227;o se associaram &#224; fragilidade e diminui&#231;&#227;o do comprometimento funcional dos pacientes&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Este estudo apresenta naturais limita&#231;&#245;es ligadas &#224; popula&#231;&#227;o de institui&#231;&#227;o p&#250;blica&#44; de um &#250;nico centro&#44; e pacientes sob tratamento em servi&#231;o secund&#225;rio&#44; o que&#44; por outro lado&#44; garantiu certa homogeneidade da amostra&#44; e n&#227;o impediu a explora&#231;&#227;o de fatores entre os grupos&#46; Os &#237;ndices de gravidade s&#227;o de dif&#237;cil caracteriza&#231;&#227;o&#44; j&#225; que todos os pacientes estavam sob tratamento&#46; Fazem&#8208;se necess&#225;rios estudos de caracteriza&#231;&#227;o dessa faixa et&#225;ria&#44; j&#225; que o aumento da preval&#234;ncia das doen&#231;as cr&#244;nicas&#44; dentre elas a psor&#237;ase&#44; vem acompanhando o aumento da expectativa de vida da popula&#231;&#227;o geral&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#227;o</span><p id="par0160" class="elsevierStylePara elsevierViewall">N&#227;o houve diferen&#231;a entre apresenta&#231;&#227;o cl&#237;nica&#44; acometimento ungueal&#44; de couro cabeludo ou presen&#231;a de artrite entre o grupo de idosos e adultos portadores de psor&#237;ase avaliados&#46; Os idosos&#44; atendidos em centro de refer&#234;ncia apresentaram maiores &#237;ndices de sintomas depressivos&#44; comorbidades metab&#243;licas e fragilidade f&#237;sica em compara&#231;&#227;o aos controles idosos saud&#225;veis&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Suporte financeiro</span><p id="par0165" class="elsevierStylePara elsevierViewall">FAPESP &#40;projeto n&#176; 19&#47;06684&#8208;5&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Contribui&#231;&#227;o dos autores</span><p id="par0170" class="elsevierStylePara elsevierViewall">Giovana Viotto Cagnon Brand&#227;o&#58; Concep&#231;&#227;o do estudo&#59; coleta dos dados&#59; escrita do texto&#59; revis&#227;o e aprova&#231;&#227;o do texto final&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Elizandra Gomes Pereira&#58; Coleta dos dados&#59; escrita do texto&#59; revis&#227;o e aprova&#231;&#227;o do texto final&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Gabriela Roncada Haddad&#58; Coleta dos dados&#59; escrita do texto&#59; revis&#227;o e aprova&#231;&#227;o do texto final&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Luciane Donida Bartoli Miot&#58; Concep&#231;&#227;o do estudo&#59; revis&#227;o e aprova&#231;&#227;o do texto final&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Silvio Alencar Marques&#58; Revis&#227;o e aprova&#231;&#227;o do texto final&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">H&#233;lio Amante Miot&#58; Concep&#231;&#227;o do estudo&#59; an&#225;lise dos resultados&#59; escrita do texto&#59; revis&#227;o e aprova&#231;&#227;o do texto final&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflito de interesses</span><p id="par0200" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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                  \t\t\t\t">27 &#40;42&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">39 &#40;67&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;17&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Superior&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12 &#40;19&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14 &#40;16&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0&#44;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Hist&#243;ria familiar&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21 &#40;33&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26 &#40;41&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;463&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">PASI</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;2&#8211;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;2&#8211;11&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;332&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PASI &#8805; 10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18 &#40;28&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;410&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">BSA</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;4&#8211;15&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;4&#8211;18&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;402&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>BSA &#8805; 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;30&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">26 &#40;41&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;267&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">PGA corpo</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;2&#8211;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;2&#8211;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;734&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">PGA couro cabeludo</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;0&#8211;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;0&#8211;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;727&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Skindex&#8208;16</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sintomas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">17 &#40;0&#8211;46&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">25 &#40;0&#8211;50&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;429&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Emocional&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">23 &#40;2&#8211;63&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">27 &#40;11&#8211;73&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;219&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Funcional&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0 &#40;0&#8211;35&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;0&#8211;40&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;056&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Palmoplantar&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21 &#40;33&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;436&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Ungueal&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">46 &#40;72&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">41 &#40;64&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;449&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Onic&#243;lise&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36 &#40;56&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;44&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pittings&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;27&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;36&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Traquion&#237;quia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;11&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Artrite&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;22&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;16&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>M&#227;os&#47;punhos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7 &#40;11&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Joelhos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">RP2 &#40;IPso<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>ISem&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IMC &#8805; 30&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Perda ponderal &#62;<span class="elsevierStyleHsp" style=""></span>5&#37; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                            0 => "M&#46;A&#46; Lowes"
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Informação do artigo
ISSN: 26662752
Idioma original: Português
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2024 Novembro 24 10 34
2024 Outubro 141 90 231
2024 Setembro 204 100 304
2024 Agosto 214 131 345
2024 Julho 229 110 339
2024 Junho 157 84 241
2024 Maio 154 71 225
2024 Abril 228 101 329
2024 Março 201 107 308
2024 Fevereiro 170 110 280
2024 Janeiro 183 94 277
2023 Dezembro 86 58 144
2023 Novembro 112 86 198
2023 Outubro 56 67 123
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Anais Brasileiros de Dermatologia (Portuguese)
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