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Tsai PH, Fang YF, Chen YF, Chen CC, Chiang WY, Chang CT, Huang YJ, Liou LB. Predictors of Remission or Combined Remission and Low Disease Activity in Rheumatoid Arthritis Patients in Taiwan: A Prospective Cohort Study. J Clin Med 2024; 13:2521. [PMID: 38731049 PMCID: PMC11084563 DOI: 10.3390/jcm13092521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/15/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Objectives: This study aimed to identify predictors of remission or low disease activity (LDA) in patients with rheumatoid arthritis (RA) and low-ultrasound inflammation. Methods: A total of 80 patients with RA who fulfilled the 1987 ACR criteria for RA with a disease activity score of 28 joints (DAS28) > 3.2 were recruited. Over 1 year of therapy, we conducted blood tests every 6 months to examine erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), monocyte chemotactic protein-1 (MCP-1), neuraminidase 3 (Neu3), and α-2,3-sialyltrasnferse I (ST3Gal-1) levels in B cells and monocytes. Additionally, we evaluated physical function by using the Health Assessment Questionnaire-Disability Index (HAQ-DI). Data on demographic and clinical parameters were collected, and musculoskeletal ultrasonography was performed twice a year on 12 specific joints to assess synovial changes. One year later, we compared all collected data and laboratory or ultrasound results between patients achieving remission or LDA and those who did not in order to determine the predictors. Results: Age, the presence or absence of rheumatoid factor, and the number of conventional disease-modifying anti-rheumatic drugs used were not correlated with remission or LDA for DAS28 or Simplified Disease Activity Index formulas. However, male sex, low CRP levels, low ESR levels, and low HAQ-DI scores were associated with a higher likelihood of achieving remission or LDA for DAS28-ESR. Negative anticyclic citrullinated peptide (CCP) and low HAQ-DI scores were predictors of remission or LDA for DAS28-MCP-1. Interestingly, having less than two comorbidities is a good predictor of a combined remission/low disease activity state for SDAI and DAS28-MCP-1. Furthermore, Neu3 and ST3Gal-1 levels and ST3Gal-1/Neu3 ratios in B cells and monocytes had no significant correlation with total ultrasound scores. Nevertheless, monocyte ST3Gal-1 and Neu3 correlated significantly with DAS28-ESR >5.1 and DAS-MCP-1 >4.8 (both categories belong to high disease activity), respectively (rho = 0.609 with p = 0.012, and rho = 0.727 with p = 0.011, respectively). Monocyte ST3Gal-1/Neu3 ratios connected with DAS28-ESR >5.1 and 3.3 < SDAI ≦ 11 (low disease activity), respectively (rho = 0.662 with p = 0.005, and rho = 0.342 with p = 0.048, respectively). Conclusions: In patients with RA in Taiwan, male sex, low CRP levels, low ESR levels, and low HAQ-DI scores are predictors of remission or LDA for DAS28-ESR, which differ from the predictors for DAS28-MCP-1. Moreover, monocyte ST3Gal-1, Neu3, and their ratios correlated with different disease activity categories of DAS28-ESR, DAS28-MCP-1, and SDAI scores.
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Affiliation(s)
- Ping-Han Tsai
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan; (P.-H.T.); (C.-C.C.); (W.-Y.C.)
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan; (Y.-F.F.); (Y.-F.C.); (C.-T.C.); (Y.-J.H.)
| | - Yao-Fan Fang
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan; (Y.-F.F.); (Y.-F.C.); (C.-T.C.); (Y.-J.H.)
| | - Yen-Fu Chen
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan; (Y.-F.F.); (Y.-F.C.); (C.-T.C.); (Y.-J.H.)
| | - Chih-Chieh Chen
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan; (P.-H.T.); (C.-C.C.); (W.-Y.C.)
| | - Wen-Yu Chiang
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan; (P.-H.T.); (C.-C.C.); (W.-Y.C.)
| | - Che-Tzu Chang
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan; (Y.-F.F.); (Y.-F.C.); (C.-T.C.); (Y.-J.H.)
| | - Yun-Ju Huang
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan; (Y.-F.F.); (Y.-F.C.); (C.-T.C.); (Y.-J.H.)
| | - Lieh-Bang Liou
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan; (P.-H.T.); (C.-C.C.); (W.-Y.C.)
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan; (Y.-F.F.); (Y.-F.C.); (C.-T.C.); (Y.-J.H.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
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Sifakaki M, Gkiouras K, Lindqvist HM, Marakis G, Petropoulou A, Donini LM, Bogdanos DP, Grammatikopoulou MG. Orthorexia Nervosa Practices in Rheumatoid Arthritis: The DORA Study. Nutrients 2023; 15:nu15030713. [PMID: 36771419 PMCID: PMC9919523 DOI: 10.3390/nu15030713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/23/2023] [Accepted: 01/28/2023] [Indexed: 02/03/2023] Open
Abstract
Medical nutrition therapy (MNT) is an indisputable component of the multidisciplinary therapeutic approach in rheumatoid arthritis (RA). Previous research has suggested that in chronic disease where nutrition is an important effector of prognosis, healthy dietary choices might take an unhealthy turn, with patients developing disordered eating in the form of orthorexia nervosa (ON). ON is characterized by a pathological preoccupation with "healthy", "pure" eating, associated with restrictive dietary patterns, nutrient deficiencies and worsening disease outcomes. The aim of the present cross-sectional study was to evaluate ON tendencies in a sample of adult patients with RA. A total of 133 patients with RA were recruited, and completed the ORTO-15 questionnaire for the assessment of ON tendencies. Most of the patients were overweight/obese (53.4%). The results revealed ON tendencies in the sample, with the median ORTO-15 score reaching 36 (IQR: 33-39). Greater ON tendencies were associated with the female gender, and lowered ON tendencies with increasing age and body mass index. The present findings highlight the need for health professional awareness regarding the problem of ON in patients with RA and the importance of screening patients.
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Affiliation(s)
- Maria Sifakaki
- Department of Nutritional Sciences & Dietetics, Faculty of Health Sciences, International Hellenic University, Alexander Campus, P.O. Box 141, GR-57400 Thessaloniki, Greece
| | - Konstantinos Gkiouras
- Unit of Immunonutrition and Clinical Nutrition, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
| | - Helen M. Lindqvist
- Department of Internal Medicine and Clinical nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
| | - Georgios Marakis
- Nutrition and Food Standards Unit, Hellenic Food Authority, 124 Kifisias Avenue & Iatridou 2, GR-11526 Athens, Greece
| | - Anastasia Petropoulou
- Department of Nutritional Sciences & Dietetics, Faculty of Health Sciences, International Hellenic University, Alexander Campus, P.O. Box 141, GR-57400 Thessaloniki, Greece
| | - Lorenzo M. Donini
- Department of Experimental Medicine, Sapienza University, 00185 Rome, Italy
| | - Dimitrios P. Bogdanos
- Unit of Immunonutrition and Clinical Nutrition, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
| | - Maria G. Grammatikopoulou
- Unit of Immunonutrition and Clinical Nutrition, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, GR-41110 Larissa, Greece
- Correspondence:
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Al-Saleh J, Almarzooqi A, Negm AA. Prevalence and Predictors of Remission and Sustained Remission in Patients with Rheumatoid Arthritis from the United Arab Emirates: A Two-Year Prospective Study. Open Access Rheumatol 2023; 15:51-63. [PMID: 37192954 PMCID: PMC10183195 DOI: 10.2147/oarrr.s408894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/05/2023] [Indexed: 05/18/2023] Open
Abstract
Aim To estimate the prevalence of remission and sustained remission for more than 12 months in a cohort of patients with rheumatoid arthritis in the United Arab Emirates and explore predictors of remission and sustained remission in these patients. Methods A two-year prospective study conducted in Dubai Hospital (January 1, 2018-December 31, 2019) included all consecutive patients with rheumatoid arthritis attending the rheumatology clinic. Patients with a Simplified Disease Activity Index ≤3.3 and/or Clinical Disease Activity Index ≤2.8 in December 2018 were considered in remission and followed until December 2019. Those who maintained remission through 2019 were considered in sustained remission. Results In this study, a total of 444 patients were followed for a 12-months period. The percentage of remission achieved in RA patients was 30.4% according to the Clinical Disease Activity Index, 31.1% according to Simplified Disease Activity Index, and 50.9% according to the Value of Disease Activity Score 28 (DAS28) remission criteria. The 12-months sustained remission rates ranged from 38.3% for the ACR-EULAR to 69.3% for the DAS28. Male gender, shorter disease duration, better functioning as evaluated by the Health Assessment Questionnaire Disability Index (lower HAQ scores), and higher compliance rates are among sustained remission predictors. Conclusion Establishing "real-world" data and understanding local predictors to sustained remission is principal for implementing timely and appropriate patient-tailored strategies. These strategies include early detection, close monitoring, and enhancing treatment adherence among UAE patients.
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Affiliation(s)
- Jamal Al-Saleh
- Rheumatology, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
- Correspondence: Jamal Al-Saleh, Rheumatology, Dubai Hospital, Dubai Health Authority, P.O. 7272, Dubai, United Arab Emirates, Tel +9714-219 5506, Fax +97142195788, Email
| | - Ahlam Almarzooqi
- Rheumatology, Al Qassimi Hospital, Emirates Health Services, Sharjah, United Arab Emirates
| | - Ahmed A Negm
- Rheumatology, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
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Parisi S, Zanetti A, Carrara G, Scirè CA, Iagnocco A, Filippou G. Relationship between the prevalence of subclinical tenosynovitis and treatment in patients with RA in clinical remission: STARTER study. Rheumatology (Oxford) 2022; 62:1485-1492. [PMID: 36066434 DOI: 10.1093/rheumatology/keac518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/04/2022] [Accepted: 08/30/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study is a sub-analysis from the patient cohort of the STARTER (Sonographic Tenosynovitis Assessment in RheumaToid arthritis patiEnts in Remission) study. The aim was to evaluate differences in ultrasound-detected joint and/or tendon involvement between patients receiving therapies based on a combination of csDMARDs and bDMARDs and those who were treated with either csDMARDs or bDMARDs in monotherapy. METHODS 427 consecutive patients with a diagnosis of rheumatoid arthritis were recruited between October 2013 and June 2014.They were divided into 3 subgroups based on their therapy at baseline: patients with bDMARDs in monotherapy, patients with csDMARDs in monotherapy, patients in combination therapy (csDMARD+bDMARD). At baseline, 6 months and 12 months, a clinical examination (28 joint count), an ultrasound evaluation were performed in each patient. A score of Grey Scale (GS) and Power Doppler (PD)-synovitis and -tenosynovitis, was calculated based on the OMERACT scoring systems. RESULTS 256 patients completed the observation period: 48 patients from the bDMARDs group (19.7%), 152 patients from the csDMARDs group (59.1%) and 56 pts from csDMARD+bDMARD group (21.8%).The analysis has shown that GS-tenosynovitis and PD-tenosynovitis are better controlled in combination therapy than they are with csDMARDs alone (p:0.025 and p:0.047, respectively); for PD synovitis, there was a better response in those who were treated with the combination therapy when compared to the patients in csDMARD (p:0.01) and those in bDMARD (p:0.02). CONCLUSION The analysis showed a lower prevalence of subclinical inflammatory manifestations detected with ultrasound imaging in those patients treated with the combination therapy than in those in monotherapy.
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Affiliation(s)
- Simone Parisi
- Rheumatology Unit, AOU Città Della Salute e della Scienza di Torino, Turin, Italy
| | - Anna Zanetti
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | - Greta Carrara
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | - Carlo Alberto Scirè
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy.,School of Medicine, University of Milano Bicocca, Milan, Italy, Milan, Italy
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Università degli Studi di Torino, Turin, Italy
| | - Georgios Filippou
- IRCCS Istituto Ortopedico Galeazzi, Department of Rheumatology, Milan, Italy
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Larid G, Vix J, Garlantezec R, Loppin E, Gervais E. Increased remission with fewer corticosteroids and more biologics in rheumatoid arthritis at 7-year follow-up in real-life conditions. Sci Rep 2022; 12:2563. [PMID: 35169251 PMCID: PMC8847581 DOI: 10.1038/s41598-022-06584-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/12/2022] [Indexed: 11/09/2022] Open
Abstract
Remission in rheumatoid arthritis (RA) is an important therapeutic target that is not easy to achieve in real-life conditions. Some prognostic factors have been identified but the literature is variable. The objectives of this study were to evaluate the remission rate and the maintenance of remission in patients with RA over 7 years of follow-up in real-life conditions and to identify prognostic factors of long-term remission. Patients with RA seen at the Poitiers University Hospital were identified and clinical and biological data were collected. Data were analysed after 1 year and 7 years. Twice as many patients were in remission at 7 years than at 1 year of follow-up. 48.6% of patients who were not in remission at 1 year obtained remission at 7 years of follow-up. Patients achieving remission were more often receiving coprescription of csDMARDs and bDMARDs. Patients not in remission at 7 years were given more corticosteroids at higher doses. After 7 years of follow-up, low initial disease activity and use of csDMARDs and bDMARDs appeared to be independent positive predictive factors. Once obtained at one year, remission was maintained for 76% of our patients. As a conclusion, modern management of RA, whatever disease duration, leads to remission rates similar to those of early RA after 7 years of follow-up.
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Affiliation(s)
- Guillaume Larid
- Rheumatology Department, University Hospital of Poitiers, CHU de Poitiers, 2 Rue de la Milétrie, 86021, Poitiers, France.,LITEC Laboratory, EA 4331, Poitiers University, Poitiers, France
| | - Justine Vix
- Rheumatology Department, University Hospital of Poitiers, CHU de Poitiers, 2 Rue de la Milétrie, 86021, Poitiers, France
| | | | - Elodie Loppin
- Rheumatology Department, University Hospital of Poitiers, CHU de Poitiers, 2 Rue de la Milétrie, 86021, Poitiers, France
| | - Elisabeth Gervais
- Rheumatology Department, University Hospital of Poitiers, CHU de Poitiers, 2 Rue de la Milétrie, 86021, Poitiers, France. .,LITEC Laboratory, EA 4331, Poitiers University, Poitiers, France.
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Vicente GNS, Pereira IA, de Castro GRW, da Mota LMH, Carnieletto AP, de Souza DGS, da Gama FO, Santos ABV, de Albuquerque CP, Bértolo MB, Júnior PL, Giorgi RDN, Radominski SC, Guimarães MFBR, Bonfiglioli KR, Sauma MDFLDC, Brenol CV, da Rocha Castelar Pinheiro G. Cardiovascular risk comorbidities in rheumatoid arthritis patients and the use of anti-rheumatic drugs: a cross-sectional real-life study. Adv Rheumatol 2021; 61:38. [PMID: 34172097 DOI: 10.1186/s42358-021-00186-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/17/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a common autoimmune systemic inflammatory disease. In addition to joint involvement, RA patients frequently have other comorbidities, such as cardiovascular diseases. Drugs used for RA treatment may increase or decrease the risk of a cardiovascular event. This study aims to analyze cardiovascular risk comorbidities in patients with RA and the correlation with the use of anti-rheumatic drugs. METHODS Cross-sectional study conducted based on the real-life rheumatoid arthritis study database - REAL, a prospective observational cohort study. Associations between the use of anti-rheumatic drugs and the presence of comorbidities were represented by their prevalence ratio and evaluated using the Chi-square or Fisher's Exact tests. RESULTS We assessed 1116 patients, 89.4% women, mean age of 55.15 years and predominance of seropositive disease. 63.3% had some cardiovascular comorbidity, predominantly hypertension (49.9%). The use of glucocorticoids was observed in 47.4% of patients and there was a significant tendency of lower use of these drugs in the presence of dyslipidemia (PR: 0.790; p = 0.007). We observed that the presence of cardiovascular comorbidities was associated with higher use of bDMARDs (PR:1.147; p = 0.003). CONCLUSIONS The presence of cardiovascular risk comorbidities was confirmed to be higher in RA patients. Different treatment strategies using less glucocorticoids in the presence of dyslipidemia and more common use of bDMARDs in patients with cardiovascular comorbidities suggest that rheumatologists are aware of the potential influence of the DMARDs in the risk of cardiovascular event. Reinforcing these results, we highlight the need for a better baseline assessment to guide the choice of anti-rheumatic drugs in RA patients who have comorbidities.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Manoel Barros Bértolo
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | | | - Rina Dalva Neubarth Giorgi
- Instituto de Assistência Médica ao Servidor Público Estadual, Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil
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Castillo-Cañón JC, Trujillo-Cáceres SJ, Bautista-Molano W, Valbuena-García AM, Fernández-Ávila DG, Acuña-Merchán L. Rheumatoid arthritis in Colombia: a clinical profile and prevalence from a national registry. Clin Rheumatol 2021; 40:3565-3573. [PMID: 33772350 DOI: 10.1007/s10067-021-05710-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/24/2021] [Accepted: 03/21/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND There is a need to describe the demographic and clinical characteristics of people diagnosed with rheumatoid arthritis who are attended within the Colombian health system. This characterization allows prioritizing populations with specific risks, programming the use of health services, and planning the costs necessary to guarantee equitable care. OBJECTIVE To assess the demographic and clinical characteristics of a cohort of patients with rheumatoid arthritis using national data collected by the High-Cost Disease Fund (CAC in Spanish). METHODS A cross-sectional study from a secondary source. Data was gathered from a national administrative registry. A descriptive analysis was performed on sociodemographic and clinical characteristics. Age-standardized prevalence was estimated at national level and by geographical regions. Remission rates were also estimated for Colombian departments and regions. RESULTS By 2019, 81,386 patients with rheumatoid arthritis were reported in Colombia. The relation female-male was 5.2:1. The median age was 59 years (IQR: 50-67). Prevalence was higher in people aged 50-69 years. The most frequent comorbidities were high blood pressure (31.15%) and osteoporosis (19.46%). Age-standardized prevalence of rheumatoid arthritis was 0.24 per 100 population (95% CI: 0.23-0.24). In cases with complete information, 57.57% of departments had remission rates up to 30%. CONCLUSION Rheumatoid arthritis in Colombia was more frequent in females aged ≥50 year. Age-standardized prevalence was lower than reported by other studies performed in Colombia but similar to the estimated internationally for the country. Key Points • More than 80,000 rheumatoid arthritis patients were reported to this national registry in Colombia in 2019, finding an age-standardized prevalence of 0.24 per 100 population. • Hypertension was the most common comorbidity reported in people with rheumatoid arthritis. This finding is similar to the reports by similar studies such as the COMORA. • A major strength of this study is the large sample size since data come from a nationwide registry of people with rheumatoid arthritis, supported by the National Ministry of Health. Additionally, this registry has a rigorous data monitoring process that guarantees the internal validity of data and provides valuable information for decision-making based on local evidence. • Prevalence of rheumatoid arthritis was higher in females between 50 and 65 years. Age-standardized prevalence was lower than previously reported in Colombia, but similar to the world estimations.
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Affiliation(s)
| | | | - Wilson Bautista-Molano
- University Hospital Fundación Santa Fe de Bogotá, Universidad El Bosque, Bogotá D.C., Colombia
| | | | - Daniel G Fernández-Ávila
- Rheumatology Unit, Department of Internal Medicine, Hospital Universitario San Ignacio-School of Medicine, Pontificia Universidad Javeriana, Bogotá D.C., Colombia
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Autoantibodies against a novel citrullinated fibrinogen peptide related to smoking status, disease activity and therapeutic response to methotrexate in cuban patients with early rheumatoid arthritis. Rheumatol Int 2020; 40:1873-1881. [DOI: 10.1007/s00296-020-04580-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/07/2020] [Indexed: 02/07/2023]
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