Artropatia por chumbo: análise sistemática de casos.

Abstract

Most lead poisoning cases are related to occupational exposure or oral ingestion, but the secondary toxicity retained projectile fragments has been well documented. Once in contact with synovial fluid, lead has the ability to dissolve and deposit on the synovial surfaces, causing an inflammatory reaction facilitated by local friction force, which leads to dispersion of the metal. Chronic inflammatory synovial usually leads to a large damage to the synovial capsule and the surface of the articular cartilage. Objectives: To identify the clinical and epidemiological features of arthropathy cases of lead and to analyze the temporal relationship between the injury by firearm and the onset of joint symptoms. Methods: The study design consists of a secondary and systematic analysis reporting of data and number of lead poisoning cases with joint involvement. Results: A total of 1137 articles for systematic search and active search that through the inclusion and exclusion criteria, we selected 35 articles to be analyzed in the study. The lead to arthropathy associated predominated in male patients where as predominant the age group was between 31 and 40 years. The most prevalent source was firearm, with early clinical presentation between one and five years after contact. The principal clinical changes were abdominal pain (73%), anemia (70%), behavioral or personality changes such as irritability and changes in social life (10%). The most affected joint was the which presented in 56.4% of cases; the presence of projectiles and fragments or lead were the most frequent radiographic change. There was a predominance of synovial abnormalitis (with or without arthritis / arthralgia), corresponding to 56.4% of the reports, and among cases whith synovial macroscopic abnormalities, there were metal fragments (72 , 7%) and degeneration of the articular surface (63.6%). In relation to serum levels of lead, a majority of 28.2% presented values between 51 and 100 mcg / dl. A majority of 64.2% of reported cases presented association between arthropathy and poisoning by lead. The most effective treatment was the use of lead chelating associated to surgical removal. Conclusions: The lack of systematic studies stimulated the authors to develop the project, basedow evidence-based medicine. This fact can be due to a few diagnoses made, often by wide variation between the contact lead and the presentation of clinical manifestations, as the causal association. In this study, most of the cases had a reported period between one and five years. The male and aged between 31 and 40 years were prevalent. Among the treatment options the most commonly used is surgical treatment associated with clinical treatment. A majority of 64.2% of reported cases presented an association between arthropathy and poisoning by lead, due to the presence of such altered laboratorial level or value associated to arthropathy.