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Espinola N, Secco A, Balan D, Kanevsky D, Calvi G, Morisset P, Bardach A, Augustovski F. Budget impact of upadacitinib in patients with moderate to severe rheumatoid arthritis in Argentina. Rev Peru Med Exp Salud Publica 2024; 41:129-139. [PMID: 39166635 PMCID: PMC11300694 DOI: 10.17843/rpmesp.2024.412.12934] [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: 06/12/2023] [Accepted: 04/17/2024] [Indexed: 08/23/2024] Open
Abstract
OBJECTIVES. To analyze the budget impact of upadacitinib (UPA) 15 mg + methotrexate (MTX) for the treatment of moderate-to-severe rheumatoid arthritis (RA) in patients with an inadequate response to conventional disease-modifying antirheumatic drugs (cDMARD-IR) from the perspective of social security and the private health sector in Argentina. MATERIALS AND METHODS. A budget impact analysis model was developed for a hypothetical cohort of 100,000 adults with health insurance coverage who were diagnosed with RA over a 5-year time horizon. The model parameters were obtained through literature review and validated by local experts. The costs are expressed in 2024 US dollars (USD). RESULTS. The introduction of UPA 15 mg + MTX for the treatment of moderate-to-severe RA and cDMARD-IR resulted in minimal increase, with a five-year total cumulative incremental cost of USD 1,855 for social security and USD 1,812 for the private health sector, representing 2% of the total budget. The acquisition cost of UPA was the most influential variable in the sensitivity analysis. CONCLUSIONS. The introduction of UPA 15 mg + MTX for the treatment of moderate-to-severe RA and cDMARD-IR can provide an effective treatment option with a minimal increase in costs for the healthcare system in Argentina, which is especially important in developing countries where health system budgets are more limited. Providing evidence-based estimates is a valuable tool for informing healthcare policies and can help policymakers make informed decisions about the allocation of healthcare resources to improve patient outcomes while also managing costs. Motivation for the study. Rheumatoid arthritis (RA) is a disease that hasn’t cure, so it’s important to know the budget impact of treatment with upadacitinib (UPA) 15 mg + methotrexate (MTX) in patients with moderate to severe RA who didn’t respond well to conventional antirheumatic drugs. Main findings. UPA + MTX would entail a minimal increase in costs for the healthcare system in Argentina, potentially making this effective treatment option more accessible to patients with RA. Access to this treatment can improve the outcome of patients with RA. Public health implications. In resource-constrained settings such as Argentina, providing evidence-based cost estimates can help healthcare managers allocate resources efficiently while improving patient outcomes. This study provides evidence to inform healthcare policies and decisions regarding the inclusion of UPA + MTX in treatment guidelines or formularies for RA management.
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Affiliation(s)
- Natalia Espinola
- Instituto de Efectividad Clínica y Sanitaria, Ciudad de Buenos Aires, Argentina.Instituto de Efectividad Clínica y SanitariaCiudad de Buenos AiresArgentina
| | - Anastasia Secco
- Instituto de Efectividad Clínica y Sanitaria, Ciudad de Buenos Aires, Argentina.Instituto de Efectividad Clínica y SanitariaCiudad de Buenos AiresArgentina
| | - Dario Balan
- Instituto de Efectividad Clínica y Sanitaria, Ciudad de Buenos Aires, Argentina.Instituto de Efectividad Clínica y SanitariaCiudad de Buenos AiresArgentina
| | - Diego Kanevsky
- AbbVie Argentina, Buenos Aires, Argentina.AbbVie ArgentinaBuenos AiresArgentina
| | - Guido Calvi
- AbbVie Argentina, Buenos Aires, Argentina.AbbVie ArgentinaBuenos AiresArgentina
| | - Pierre Morisset
- AbbVie Argentina, Buenos Aires, Argentina.AbbVie ArgentinaBuenos AiresArgentina
| | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria, Ciudad de Buenos Aires, Argentina.Instituto de Efectividad Clínica y SanitariaCiudad de Buenos AiresArgentina
| | - Federico Augustovski
- Instituto de Efectividad Clínica y Sanitaria, Ciudad de Buenos Aires, Argentina.Instituto de Efectividad Clínica y SanitariaCiudad de Buenos AiresArgentina
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Wang J, Vordenbäumen S, Schneider M, Brinks R. Population-based epidemiological projections of rheumatoid arthritis in Germany until 2040. Scand J Rheumatol 2024; 53:161-172. [PMID: 38358097 DOI: 10.1080/03009742.2024.2312693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/29/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVES Our aim was to conduct a population-based projection to estimate the number of rheumatoid arthritis (RA) cases in Germany until 2040. METHOD Data obtained from a report published in 2017 (doi:10.20364/VA-17.08) were used for future prediction analysis. The data were originally collected by the German Central Institute for Statutory Health Insurance. We used the illness-death model to estimate future numbers of RA cases, considering nine possible scenarios based on different incidence and mortality rates. RESULTS In the baseline scenario, the number of women with RA is projected to increase by 417 000 cases and men by 179 000 cases by 2040, compared with 2015. Peak numbers of cases are concentrated in the 70-80-year-old age group, particularly among women. In the most favourable scenario (scenario 2), assuming a decreasing incidence, the total number of RA cases is projected to rise by 284 000 by 2040, reflecting a 38% relative increase from 2015 to 2040. The least favourable scenario (scenario 9), assuming an increasing incidence, projects a significant burden on the healthcare system. The total number of RA cases is expected to rise by 1.16 million by 2040, marking a substantial 158% relative increase from 2015 to 2040. CONCLUSIONS Our research emphasizes a discernible trend: with an ageing society, improving treatment effectiveness, and declining all-cause mortality, we anticipate a rise in the absolute numbers of RA cases in Germany in the coming years. Our models robustly support this viewpoint, underscoring impending challenges for healthcare systems. Addressing these challenges demands multifaceted interventions.
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Affiliation(s)
- J Wang
- Institute of Biometry and Epidemiology, The German Diabetes Center, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - S Vordenbäumen
- Department of Rheumatology, St. Elisabeth-Hospital Meerbusch-Lank, Meerbusch, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - M Schneider
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - R Brinks
- Chair for Medical Biometry and Epidemiology, University of Witten/Herdecke, Witten, Germany
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Alvarado RN, Alle G, Tobar-Jaramillo MA, Palomino LC, Cáceres AG, Rosa JE, Machnicki G, Zazzetti F, Soriano E, Scolnik M. Burden of lupus activity on health care resources utilization in Buenos Aires, Argentina. Lupus 2023; 32:1656-1665. [PMID: 37955177 DOI: 10.1177/09612033231215386] [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] [Indexed: 11/14/2023]
Abstract
OBJECTIVE The aim is to analyze health care resource utilization (HCRU) of patients with lupus (SLE) from a health management organization (HMO) in Buenos Aires, Argentina, compared with matched controls and comparing periods of flare, low disease activity, and remission. METHODS This is a retrospective observational study including all SLE incident cases (ACR 1997/SLICC 2012 criteria) between 2000 and 2020 and 5 matched controls. Clinical data and HCRU (medical and nonmedical consultations, lab and imaging tests performed, emergency room visits, hospitalizations, and drugs prescribed) were obtained from administrative databases and electronic medical records. For each patient with SLE, an activity state was determined in every month of follow-up: flare (BILAG A or 2 BILAG B); low disease activity (LLDAS); remission (DORIS definition); or intermediate activity (not fulfilling any of previous). Incidence rates for each HCRU item and incidence rate ratios between SLE and control patients were and between remission and flare periods were calculated. Multivariate negative binomial logistic regression analyses were performed for identification of variables associated with major resource use. RESULTS A total of 62 SLE and 310 control patients were included, 88.7% were women, the median age at diagnosis was 46 years, and were followed for more than 8 years. Patients with SLE contributed with 537.2 patient-years (CI 95% 461.1-613.3) and controls with 2761.9 patient-years (CI 95% 2600.9-2922.8). HCRU in patients with SLE was significantly higher than in controls in all items, even in remission periods. Patients with SLE remained 74.4% of the time in remission, 12.1% in LLDAS, 12.2% in intermediate activity, and 1.3% in flare (there were 64 flares in 36 patients). HCRU was significantly higher during flare periods compared with remission periods. Number of flares was independently associated with emergency department consultations, lab tests and X-ray performed, number of drugs prescribed, and hospitalizations. CONCLUSION Significantly more HCRU was observed in patients with SLE in flare compared to remission periods.
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Affiliation(s)
| | - Gelsomina Alle
- Department of Rheumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Luis Carlos Palomino
- Department of Rheumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Javier Eduardo Rosa
- Department of Rheumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Federico Zazzetti
- Janssen Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson and Johnson, Titusville, NJ, USA
| | - Enrique Soriano
- Department of Rheumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Marina Scolnik
- Department of Rheumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Martínez Perez JM, Mollerach FB, Scaglioni V, Vergara F, Gandino IJ, Catoggio LJ, Rosa JE, Soriano ER, Scolnik M. Incidence and Prevalence of Polymyalgia Rheumatica and Giant Cell Arteritis in a Healthcare Management Organization in Buenos Aires, Argentina. J Rheumatol 2023; 50:93-97. [PMID: 36243415 DOI: 10.3899/jrheum.220084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To estimate incidence and prevalence of polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) in a university hospital-based health management organization (Hospital Italiano Medical Care Program) in Argentina. METHODS Overall and sex-specific incidence rates (IRs) and prevalence were calculated (age ≥ 50 yrs). Incidence study followed members with continuous affiliation ≥ 1 year from January 2000 to December 2015. Diagnosis as per the 2012 European Alliance of Associations for Rheumatology/American College of Rheumatology (ACR) criteria for PMR or the ACR 1990 criteria for GCA. Prevalence was calculated on January 1, 2015. RESULTS There were 176,558 persons who contributed a total of 1,046,620 person-years (PY). Of these, 825 developed PMR, with an IR (per 100,000 PY) of 78.8 (95% CI 73.4-84.2) overall, 90.1 (95% CI 82.9-97.2) for women, and 58.9 (95% CI 51.1-66.6) for men. Ninety persons developed GCA; the IR was 8.6 (95% CI 6.8-10.4) overall, 11.1 (95% CI 8.5-10.6) for women, and 4.2 (2.2-6.3) for men. There were 205 prevalent PMR cases and 23 prevalent GCA cases identified from a population of 80,335. Prevalence of PMR was 255 per 100,000 (95% CI 220-290) overall, 280 (95% CI 234-325) for women, and 209 (95% CI 150-262) for men; and the prevalence of GCA was 28.6 per 100,000 (95% CI 16.9-40.3) overall, 36.4 (95% CI 20.1-52.8) for women, and 14.2 (95% CI 0.3-28.1) for men. CONCLUSION This is the first study of incidence and prevalence of PMR and GCA in Argentina. There were similarities and differences with cohorts from other parts of the world, but population-based epidemiologic studies in Latin America are needed.
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Affiliation(s)
- José Maximiliano Martínez Perez
- J.M. Martínez Perez, MD, F.B. Mollerach, MD, V. Scaglioni, MD, F. Vergara, MD, I.J. Gandino, MD, L.J. Catoggio, PhD, J. E. Rosa, MSc, E.R. Soriano, MSc, M. Scolnik, MD, Rheumatology Section, Hospital Italiano de Buenos Aires, Argentina
| | - Florencia Beatriz Mollerach
- J.M. Martínez Perez, MD, F.B. Mollerach, MD, V. Scaglioni, MD, F. Vergara, MD, I.J. Gandino, MD, L.J. Catoggio, PhD, J. E. Rosa, MSc, E.R. Soriano, MSc, M. Scolnik, MD, Rheumatology Section, Hospital Italiano de Buenos Aires, Argentina
| | - Valeria Scaglioni
- J.M. Martínez Perez, MD, F.B. Mollerach, MD, V. Scaglioni, MD, F. Vergara, MD, I.J. Gandino, MD, L.J. Catoggio, PhD, J. E. Rosa, MSc, E.R. Soriano, MSc, M. Scolnik, MD, Rheumatology Section, Hospital Italiano de Buenos Aires, Argentina
| | - Facundo Vergara
- J.M. Martínez Perez, MD, F.B. Mollerach, MD, V. Scaglioni, MD, F. Vergara, MD, I.J. Gandino, MD, L.J. Catoggio, PhD, J. E. Rosa, MSc, E.R. Soriano, MSc, M. Scolnik, MD, Rheumatology Section, Hospital Italiano de Buenos Aires, Argentina
| | - Ignacio Javier Gandino
- J.M. Martínez Perez, MD, F.B. Mollerach, MD, V. Scaglioni, MD, F. Vergara, MD, I.J. Gandino, MD, L.J. Catoggio, PhD, J. E. Rosa, MSc, E.R. Soriano, MSc, M. Scolnik, MD, Rheumatology Section, Hospital Italiano de Buenos Aires, Argentina
| | - Luis José Catoggio
- J.M. Martínez Perez, MD, F.B. Mollerach, MD, V. Scaglioni, MD, F. Vergara, MD, I.J. Gandino, MD, L.J. Catoggio, PhD, J. E. Rosa, MSc, E.R. Soriano, MSc, M. Scolnik, MD, Rheumatology Section, Hospital Italiano de Buenos Aires, Argentina
| | - Javier Eduardo Rosa
- J.M. Martínez Perez, MD, F.B. Mollerach, MD, V. Scaglioni, MD, F. Vergara, MD, I.J. Gandino, MD, L.J. Catoggio, PhD, J. E. Rosa, MSc, E.R. Soriano, MSc, M. Scolnik, MD, Rheumatology Section, Hospital Italiano de Buenos Aires, Argentina
| | - Enrique Roberto Soriano
- J.M. Martínez Perez, MD, F.B. Mollerach, MD, V. Scaglioni, MD, F. Vergara, MD, I.J. Gandino, MD, L.J. Catoggio, PhD, J. E. Rosa, MSc, E.R. Soriano, MSc, M. Scolnik, MD, Rheumatology Section, Hospital Italiano de Buenos Aires, Argentina
| | - Marina Scolnik
- J.M. Martínez Perez, MD, F.B. Mollerach, MD, V. Scaglioni, MD, F. Vergara, MD, I.J. Gandino, MD, L.J. Catoggio, PhD, J. E. Rosa, MSc, E.R. Soriano, MSc, M. Scolnik, MD, Rheumatology Section, Hospital Italiano de Buenos Aires, Argentina.
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5
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Finckh A, Gilbert B, Hodkinson B, Bae SC, Thomas R, Deane KD, Alpizar-Rodriguez D, Lauper K. Global epidemiology of rheumatoid arthritis. Nat Rev Rheumatol 2022; 18:591-602. [PMID: 36068354 DOI: 10.1038/s41584-022-00827-y] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 11/09/2022]
Abstract
Rheumatoid arthritis (RA) is a systemic autoimmune disease that predominantly affects the joints. The prevalence of RA varies globally, with generally a higher prevalence in industrialized countries, which may be explained by exposures to environmental risk factors, but also by genetic factors, differing demographics and under-reporting in other parts of the world. Over the past three decades, strong trends of the declining severity of RA probably reflect changes in treatment paradigms and overall better management of the disease. Other trends include increasing RA prevalence. Common risk factors for RA include both modifiable lifestyle-associated variables and non-modifiable features, such as genetics and sex. A better understanding of the natural history of RA, and of the factors that contribute to the development of RA in specific populations, might lead to the introduction of specific prevention strategies for this debilitating disease.
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Affiliation(s)
- Axel Finckh
- Division of Rheumatology, Department of Medicine, Geneva University Hospital (HUG), Geneva, Switzerland.
| | - Benoît Gilbert
- Division of Rheumatology, Department of Medicine, Geneva University Hospital (HUG), Geneva, Switzerland
| | - Bridget Hodkinson
- Division of Rheumatology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Hanyang University Institute for Rheumatology and Hanyang University Institute of Bioscience and Biotechnology, Seoul, Republic of Korea
| | - Ranjeny Thomas
- The University of Queensland Diamantina Institute, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Kevin D Deane
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Kim Lauper
- Division of Rheumatology, Department of Medicine, Geneva University Hospital (HUG), Geneva, Switzerland.,Centre for Epidemiology versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
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6
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Masson W, Rossi E, Alvarado RN, Cornejo-Peña G, Damonte JI, Fiorini N, Mora-Crespo LM, Tobar-Jaramillo MA, Scolnik M. Rheumatoid Arthritis, Statin Indication and Lipid Goals: Analysis According to Different Recommendations. REUMATOLOGIA CLINICA 2022; 18:266-272. [PMID: 35568440 DOI: 10.1016/j.reumae.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 02/13/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Different strategies have been proposed for the cardiovascular risk management of patients with rheumatoid arthritis (RA). OBJECTIVES (1) To estimate the cardiovascular risk by different strategies in RA patients, analyzing which proportion of patients would be candidates to receive statin therapy; (2) to identify how many patients meet the recommended lipid goals. METHODS A cross-sectional study was performed from a secondary database. The QRISK-3 score, the Framingham score (adjusted for a multiplying factor×1.5), the ASCVD calculator and the SCORE calculator were estimated. The indications for statin therapy according to NICE, Argentine Consensus, ACC/AHA, and new European guidelines were analyzed. The recommended LDL-C goals were analyzed. RESULTS A total of 420 patients were included. In total, 24.7% and 48.7% of patients in primary and secondary prevention were receiving statins, respectively. Only 19.4% of patients with cardiovascular history received high intensity statins. Applying the ACC/AHA guidelines (based on ASCVD score), the Argentine Consensuses (based on adjusted Framingham score), the NICE guidelines (based on QRISK-3) and European recommendations (based on SCORE), 26.9%, 26.5%, 41.1% and 18.2% of the population were eligible for statin therapy, respectively. Following the new European recommendations, 50.0%, 46.2% and 15.9% of the patients with low-moderate, high or very high risk achieved the suggested lipid goals. CONCLUSION Applying four strategies for lipid management in our population, the cardiovascular risk stratification and the indication for statins were different. A significant gap was observed when comparing the expected and observed statin indication, with few patients achieving the LDL-C goals.
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Affiliation(s)
- Walter Masson
- Servicio de Cardiología, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB Ciudad Autónoma de Buenos Aires, Argentina.
| | - Emiliano Rossi
- Servicio de Cardiología, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB Ciudad Autónoma de Buenos Aires, Argentina
| | - Rodolfo N Alvarado
- Servicio de Reumatología, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB Ciudad Autónoma de Buenos Aires, Argentina
| | - Guillermo Cornejo-Peña
- Servicio de Cardiología, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB Ciudad Autónoma de Buenos Aires, Argentina
| | - Juan I Damonte
- Servicio de Cardiología, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB Ciudad Autónoma de Buenos Aires, Argentina
| | - Norberto Fiorini
- Servicio de Cardiología, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB Ciudad Autónoma de Buenos Aires, Argentina
| | - Lorena M Mora-Crespo
- Servicio de Cardiología, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB Ciudad Autónoma de Buenos Aires, Argentina
| | - Mayra A Tobar-Jaramillo
- Servicio de Reumatología, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB Ciudad Autónoma de Buenos Aires, Argentina
| | - Marina Scolnik
- Servicio de Reumatología, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB Ciudad Autónoma de Buenos Aires, Argentina
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Papadimitropoulos E, Brnabic A, Vorstenbosch E, Leonardi F, Moyano S, Gomez D. The burden of illness of rheumatoid arthritis in Latin America-A systematic literature review. Int J Rheum Dis 2022; 25:405-421. [PMID: 35102697 DOI: 10.1111/1756-185x.14295] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 11/19/2021] [Accepted: 12/21/2021] [Indexed: 11/30/2022]
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disease which, when left untreated, may result in the destruction of multiple joints and damage a wide variety of body systems, including the skin, eyes, lungs, heart, and blood vessels. The objective of this study was to conduct a systematic review of disease burden for RA in Argentina, Brazil, Colombia, Mexico, and Venezuela. PubMed/Medline, Embase, and Web of Science were searched for publications in English, Spanish, or Portuguese from 2008 through June 2018. A total of 1700 records were retrieved and 36 articles were included. The estimated prevalence of RA for these countries ranged from 0.15% (Colombia) to 2.8% (Mexico). The Global Burden of Disease initiative 2019 estimated that RA accounted for 0.13% of world disability-adjusted life-years. For Latin America, these figures were higher: Argentina 0.16%, Brazil 0.16%, Colombia 0.21%, Mexico 0.30%, and Venezuela 0.24%. RA has a negative impact on physical, mental, and emotional well-being as shown by substantially lower scores on measures of quality of life (SF-36) compared with the general population. The annual direct cost in Mexico was estimated at US$3599 per person. For patients with severe RA in Brazil these costs were approximately US$10 000. Data from other studied countries were similar. Though evidence of the full cost and impact of RA in Latin American countries is scarce and additional studies are needed, the burden of RA in these regions is significant and comparable to other parts the world.
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Affiliation(s)
- Emmanuel Papadimitropoulos
- Eli Lilly and Company, Toronto, Ontario, Canada.,Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Alan Brnabic
- Eli Lilly and Company, Sydney, New South Wales, Australia
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Germano JL, Reis-Pardal J, Tonin FS, Pontarolo R, Melchiors AC, Fernandez-Llimos F. Prevalence of rheumatoid arthritis in South America: a systematic review and meta-analysis. CIENCIA & SAUDE COLETIVA 2021; 26:5371-5382. [PMID: 34787226 DOI: 10.1590/1413-812320212611.3.05152020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 04/20/2020] [Indexed: 11/22/2022] Open
Abstract
Rheumatoid arthritis (RA) is among the most prevalent chronic autoimmune and inflammatory diseases worldwide. The aim of this study was to establish a pooled estimate of the RA prevalence in South America by means of a meta-analysis of the available epidemiologic studies. Systematic searches in PubMed, Lilacs, SciELO, Scopus, and Web of Science databases (updated May 2019) were done followed by a systematic grey literature search to identify original research articles and reports, published after 2000, providing data of RA prevalence in any South American country. Proportion meta-analysis of weighted pooled was performed, with between-trial heterogeneity assessed by the inconsistency relative index. Sensitivity analyses and sub-group analyses were also done. A total of 25 articles, representing 27 population-based studies were included. Pooled prevalence of RA resulted in 0.48% with 591,981 cases in a population of 114,537,812 individuals (I2=99%). Brazil and Colombia presented the lowest rates of RA prevalence 0.22%, and 0.24%, respectively. RA prevalence in indigenous population was higher 1.45%, and studies using COPCORD method reported also the highest rates 1.07%.
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Affiliation(s)
- Jaqueline L Germano
- Secretaria de Estado da Saúde do Paraná. R. Piquiri 170, Rebouças. 80230-140 Curitiba PR Brasil. .,Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal do Paraná (UFPR). Curitiba PR Brasil
| | - Joana Reis-Pardal
- Departamento de Farmácia, Hospital de Sant'Ana, Santa Casa da Misericórdia de Lisboa. Parede Portugal
| | - Fernanda S Tonin
- Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal do Paraná (UFPR). Curitiba PR Brasil
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Isnardi CA, Capelusnik D, Schneeberger EE, Bazzarelli M, Berloco L, Blanco E, Benítez CA, Luján Benavidez F, Scarafia S, Lázaro MA, Pérez Alamino R, Colombres F, Kohan MP, Sosa J, Gonzalez Lucero L, Barbaglia AL, Maldonado Ficco H, Citera G. Depression Is a Major Determinant of Functional Capacity in Rheumatoid Arthritis. J Clin Rheumatol 2021; 27:S180-S185. [PMID: 32732521 DOI: 10.1097/rhu.0000000000001506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this study was to determine the prevalence of depression among rheumatoid arthritis (RA) Argentinean patients and its association with sociodemographic and clinical factors. METHODS We performed a cross-sectional study of consecutive adults with RA. Sociodemographic data, comorbidities, RA disease activity, and current treatment were assessed. The following instruments were used to evaluate quality of life (EQ-5D-3 L [EURO Quality 5-dimension 3 lines], QOL-RA [Quality of Life-Rheumatoid Arthritis]), functional capacity (HAQ-A [Health Assessment Questionnaire-Argentinean version]), and depression (PHQ-9 [Patient Health Questionnaire 9]; scores 5-9: mild, 10-14: moderate, 15-19: moderate-severe, and ≥20: severe depression, a cutoff value ≥10 is diagnostic of major depression). RESULTS Two hundred fifty-eight patients were included, with a median disease duration of 9 years (interquartile range, 3.6-16.7 years). The m PHQ-9 score was 6 (interquartile range, 2-12.3 years). The prevalence of major depression was 33.8%. The frequency of mild, moderate, moderate/severe, and severe depression was 66 (25.6%), 42 (16.3%), 27 (10.5%), and 18 (7%), respectively. Patients with major depression had worse functional capacity (HAQ-A: mean ± SD, 1.6 ± 0.8 vs. 0.7 ± 0.7; p < 0.0001), poorer quality of life (QOL-RA: mean ± SD, 5.4 ± 1.8 vs. 7.3 ± 1.6; p < 0.0001), greater pain (visual analog scale: mean ± SD, 56.2 ± 27.5 mm vs. 33.4 ± 25.7 mm; p < 0.0001), higher disease activity (Disease Activity Score in 28 joints: mean ± SD, 4.3 ± 1.4 vs. 3.3 ± 1.3; p < 0.0001), higher frequency of comorbidities (67% vs. 33%; p = 0.017), and lower frequency of physical activity (22% vs. 35%; p = 0.032). In the multivariate analysis, patients with moderate and severe depression had worse functional capacity (odds ratio, 2.1; 95% confidence interval, 1.6-4.3; p < 0.0001) and quality of life (odds ratio, 0.7; 95% confidence interval, 0.5-0.8; p < 0.0001), independently of disease activity. CONCLUSIONS A third of RA patients in this Argentinean cohort had major depression. In those patients, depression was associated with worst functional capacity and quality of life.
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Affiliation(s)
- Carolina A Isnardi
- From the Section of Rheumatology, Instituto de Rehabilitación Psicofísica, Ciudad Autónoma de Buenos Aires
| | - Dafne Capelusnik
- From the Section of Rheumatology, Instituto de Rehabilitación Psicofísica, Ciudad Autónoma de Buenos Aires
| | - Emilce Edith Schneeberger
- From the Section of Rheumatology, Instituto de Rehabilitación Psicofísica, Ciudad Autónoma de Buenos Aires
| | - Marcela Bazzarelli
- Section of Rheumatology, Hospital Interzonal General de Agudos Petrona V. de Cordero
| | - Laura Berloco
- Section of Rheumatology, Hospital Interzonal General de Agudos Petrona V. de Cordero
| | - Eliana Blanco
- Section of Rheumatology, Hospital General de Agudos Dr. Cosme Argerich, Ciudad Autónoma de Buenos Aires
| | - Cristian A Benítez
- Section of Rheumatology, Hospital General de Agudos Dr. Cosme Argerich, Ciudad Autónoma de Buenos Aires
| | - Federico Luján Benavidez
- Section of Rheumatology, Hospital General de Agudos Dr. Cosme Argerich, Ciudad Autónoma de Buenos Aires
| | | | - María A Lázaro
- Instituto de Asistencia Reumatológica Integral, Buenos Aires
| | | | | | - María P Kohan
- Section of Rheumatology, Hospital General de Agudos Dr. Enrique Tornú, Ciudad Autónoma de Buenos Aires, Buenos Aires
| | - Julia Sosa
- Section of Rheumatology, Hospital General de Agudos Dr. Enrique Tornú, Ciudad Autónoma de Buenos Aires, Buenos Aires
| | | | | | | | - Gustavo Citera
- From the Section of Rheumatology, Instituto de Rehabilitación Psicofísica, Ciudad Autónoma de Buenos Aires
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Acosta Felquer ML, LoGiudice L, Galimberti ML, Rosa J, Mazzuoccolo L, Soriano ER. Treating the skin with biologics in patients with psoriasis decreases the incidence of psoriatic arthritis. Ann Rheum Dis 2021; 81:74-79. [PMID: 34281904 DOI: 10.1136/annrheumdis-2021-220865] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/09/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To compare the incidence of psoriatic arthritis (PsA) in patients with psoriasis (PsO) according to different treatments for their skin: topics/no treatment, conventional disease-modifying antirheumatic drugs (DMARDs) (cDMARDs) or biological DMARDs (bDMARDs). METHODS Patients with PsO without PsA followed at a university hospital were included in this retrospective cohort study. Patients were classified according to their treatment in topics (topics, phototherapy or no treatment), cDMARDs (methotrexate and cyclosporine) and bDMARDs (tumour necrosis factor inhibitors (TNFi), interleukin 17 inhibitors (IL-17i) and IL-12-23i ((interleukin (IL) 12/IL-23 inhibitor))) groups. Incident cases of PsA were attributed to one treatment if developed during the administration of that treatment. A Cox proportional hazards model was used to evaluate the adjusted risk of PsA development by treatment group. RESULTS 1719 patients with PsO contributed a total of 14 721 patient/years (py). 1387 (81%) patients were in the topics, 229 (13%) in cDMARDs and 103 (6%) in the bDMARDs group. During follow-up, 239 patients (14%) developed PsA (231 under topics, six under cDMARDs and two under bDMARDs). Global incidence was 1.6 per 100 py. The risk of developing PsA in patients with PsO treated with bDMARDs was significantly lower (incidence rate ratio (IRR)=0.26; 95% CI 0.03 to 0.94; p=0.0111), compared with topics, but not compared with cDMARDs (IRR=0.35; 95% CI 0.035 to 1.96; p=0.1007). Adjusted Cox proportional hazards regression analysis showed that male sex, nail involvement and higher body max index were associated with increased risk of developing PsA, while biologics use was protective (HR: 0.19; 95% CI 0.05 to 0.81). CONCLUSION Treatment with biologics in patients with PsO reduced the risk of PsA development.
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Affiliation(s)
- Maria Laura Acosta Felquer
- Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires and Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Luciano LoGiudice
- Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires and Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Javier Rosa
- Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires and Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Luis Mazzuoccolo
- Dermatology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Enrique R Soriano
- Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires and Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Pierini FS, Brom M, Scolnik M, Scaglioni V, Rosa JE, Soriano ER. Osteoporotic fractures in rheumatoid arthritis patients in Argentina: a matched retrospective cohort study. Adv Rheumatol 2021; 61:21. [PMID: 33827708 DOI: 10.1186/s42358-021-00179-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 03/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To compare the incidence of osteoporotic fractures in patients with rheumatoid arthritis (RA) with matched controls from a university hospital. METHODS Consecutive RA patients (n = 100) were matched (age and sex) with controls (1:2). The follow-up period began at the index date, defined as the date of diagnosis for RA patients and the date of the first medical claim at the Health Management Organization (HMO) for non-RA patients. Fracture incidence rates per 1000 persons-years (PY) for distinct types of fractures were calculated. Multivariate cox regression analysis was performed to identify factors associated with fractures. RESULTS One hundred RA patients were followed for a total of 975.1 patients-years and 200 controls for 1485.7 patients-years. No difference was found in the overall fracture incidence rate per 1000 PY between RA and controls (19.5, 95% CI 12.7-28.6 vs 12.1, 95% CI 7.7-18.7, p = 0.07). In the Cox regression analysis, only age (HR 1.06, 95% CI 1.02-1.11, p = 0.006) and history of a prior fracture (HR 9.85, 95% CI 2.97-32.64, p < 0.001) were associated with fractures after the index date. The stratified analysis of the fractures by location showed that only the vertebral fractures were more frequent in RA patients compared with controls (12.9 per 1000 PY, 95% CI 8.9-25.8, vs. 3.4, 95% CI 1.4-8.1, respectively, p = 0.01). CONCLUSION Patients with RA didn't show an overall increased risk of osteoporotic fractures compared with matched controls, but vertebral fractures were more frequently observed in patients with RA.
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Affiliation(s)
- Florencia S Pierini
- Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, Perón 4190, 1181, Buenos Aires, Argentina.
| | - Martin Brom
- Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, Perón 4190, 1181, Buenos Aires, Argentina
| | - Marina Scolnik
- Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, Perón 4190, 1181, Buenos Aires, Argentina
| | - Valeria Scaglioni
- Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, Perón 4190, 1181, Buenos Aires, Argentina
| | - Javier E Rosa
- Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, Perón 4190, 1181, Buenos Aires, Argentina
| | - Enrique R Soriano
- Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, Perón 4190, 1181, Buenos Aires, Argentina
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Pierini FS, Botta E, Soriano ER, Martin M, Boero L, Meroño T, Saez MS, Lozano Chiappe E, Cerda O, Citera G, Gandino I, Rosa J, Sorroche P, Kontush A, Brites F. Effect of Tocilizumab on LDL and HDL Characteristics in Patients with Rheumatoid Arthritis. An Observational Study. Rheumatol Ther 2021; 8:803-815. [PMID: 33811316 PMCID: PMC8217399 DOI: 10.1007/s40744-021-00304-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/19/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In patients with rheumatoid arthritis (RA), qualitative alterations of low and high-density lipoproteins (LDL and HDL, respectively) might partially explain their increased cardiovascular risk. Tocilizumab has been associated with an increase in lipids, including triglyceride (TG) and cholesterol levels. The aim of this study is to evaluate the effect of tocilizumab on certain LDL and HDL characteristics (oxidized LDL levels, HDL-associated enzymes, chemical composition of both total HDL and HDL3c subpopulation, and their capacity to promote cellular cholesterol efflux) at baseline and 3 months after the start of treatment in patients with RA. METHODS Twenty-eight RA patients (ACR/EULAR 2010 criteria) with indication of treatment with tocilizumab were included in the present study. Clinical assessment [Health assessment questionnaire (HAQ)], disease activity score 28 (DAS28), high-sensitivity C reactive protein (hsCRP) concentration, lipid profile, and lipoprotein (a) [Lp(a)] levels were evaluated in all patients at baseline and after 3 months of treatment with tocilizumab. Lipoprotein characteristics were evaluated through the levels of oxidized LDL (OxLDL), the activity of paraoxonase (PON) 1, the composition of total HDL and small, dense HDL3c subpopulation, and their ability to promote cellular cholesterol efflux. RESULTS After 3 months of treatment with tocilizumab, HAQ (- 23%, p < 0.05), DAS28 (- 49%, p < 0.001), and hsCRP (- 94%, p < 0.01) levels decreased significantly. Total cholesterol (TC), LDL-C, non-HDL-C, and apo B levels showed a significant increase after treatment (TC: + 7.0%, p < 0.01; LDL-C: + 10%, p < 0.01; non-HDL-C: + 9.9%, p < 0.01; and apo B: + 9.6%, p < 0.05). Decreases in Lp(a) and OxLDL levels were also observed after treatment [Lp(a): - 50%, p < 0.01; and oxLDL: - 5.4%, p < 0.05]. The latter was in accordance with the increment detected in PON activity. No changes were observed in HDL capacity to promote cholesterol efflux (p > 0.05) in the whole group. CONCLUSIONS Treatment with tocilizumab reduced hsCRP levels and displayed positive effects on certain lipoprotein-related parameters, such as a potent decrease inLp(a) and a reduction in OxLDL levels. Moreover, HDL capacity to promote cellular cholesterol efflux was maintained after 3 months of treatment.
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Affiliation(s)
- Florencia S Pierini
- Rheumatology Unit, Internal Medical Services, and University Institute, Hospital Italiano de Buenos Aires, Peron 4190, (1181), Buenos Aires, Argentina
| | - Eliana Botta
- Laboratory of Lipids and Atherosclerosis, School of Pharmacy and Biochemistry, INFIBIOC, University of Buenos Aires, CONICET, Buenos Aires, Argentina
| | - Enrique R Soriano
- Rheumatology Unit, Internal Medical Services, and University Institute, Hospital Italiano de Buenos Aires, Peron 4190, (1181), Buenos Aires, Argentina.
| | - Maximiliano Martin
- Laboratory of Lipids and Atherosclerosis, School of Pharmacy and Biochemistry, INFIBIOC, University of Buenos Aires, CONICET, Buenos Aires, Argentina
| | - Laura Boero
- Laboratory of Lipids and Atherosclerosis, School of Pharmacy and Biochemistry, INFIBIOC, University of Buenos Aires, CONICET, Buenos Aires, Argentina
| | - Tomás Meroño
- Laboratory of Lipids and Atherosclerosis, School of Pharmacy and Biochemistry, INFIBIOC, University of Buenos Aires, CONICET, Buenos Aires, Argentina
| | - María Soledad Saez
- Central Laboratory, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ezequiel Lozano Chiappe
- Laboratory of Lipids and Atherosclerosis, School of Pharmacy and Biochemistry, INFIBIOC, University of Buenos Aires, CONICET, Buenos Aires, Argentina
| | - Osvaldo Cerda
- Rheumatology Service, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Gustavo Citera
- Rheumatology Service, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Ignacio Gandino
- Rheumatology Unit, Internal Medical Services, and University Institute, Hospital Italiano de Buenos Aires, Peron 4190, (1181), Buenos Aires, Argentina
| | - Javier Rosa
- Rheumatology Unit, Internal Medical Services, and University Institute, Hospital Italiano de Buenos Aires, Peron 4190, (1181), Buenos Aires, Argentina
| | - Patricia Sorroche
- Central Laboratory, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Anatol Kontush
- Faculty of Medicine Pitié-Salpêtrière, National Institute for Health and Medical Research (INSERM) Research Unit 1166 - ICAN, Sorbonne University, Paris, France
| | - Fernando Brites
- Laboratory of Lipids and Atherosclerosis, School of Pharmacy and Biochemistry, INFIBIOC, University of Buenos Aires, CONICET, Buenos Aires, Argentina
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Masson W, Rossi E, Alvarado RN, Cornejo-Peña G, Damonte JI, Fiorini N, Mora-Crespo LM, Tobar-Jaramillo MA, Scolnik M. Rheumatoid Arthritis, Statin Indication and Lipid Goals: Analysis According to Different Recommendations. REUMATOLOGIA CLINICA 2021; 18:S1699-258X(21)00056-5. [PMID: 33745866 DOI: 10.1016/j.reuma.2021.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/20/2021] [Accepted: 02/13/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Different strategies have been proposed for the cardiovascular risk management of patients with rheumatoid arthritis (RA). OBJECTIVES (1) To estimate the cardiovascular risk by different strategies in RA patients, analyzing which proportion of patients would be candidates to receive statin therapy; (2) to identify how many patients meet the recommended lipid goals. METHODS A cross-sectional study was performed from a secondary database. The QRISK-3 score, the Framingham score (adjusted for a multiplying factor×1.5), the ASCVD calculator and the SCORE calculator were estimated. The indications for statin therapy according to NICE, Argentine Consensus, ACC/AHA, and new European guidelines were analyzed. The recommended LDL-C goals were analyzed. RESULTS A total of 420 patients were included. In total, 24.7% and 48.7% of patients in primary and secondary prevention were receiving statins, respectively. Only 19.4% of patients with cardiovascular history received high intensity statins. Applying the ACC/AHA guidelines (based on ASCVD score), the Argentine Consensuses (based on adjusted Framingham score), the NICE guidelines (based on QRISK-3) and European recommendations (based on SCORE), 26.9%, 26.5%, 41.1% and 18.2% of the population were eligible for statin therapy, respectively. Following the new European recommendations, 50.0%, 46.2% and 15.9% of the patients with low-moderate, high or very high risk achieved the suggested lipid goals. CONCLUSION Applying four strategies for lipid management in our population, the cardiovascular risk stratification and the indication for statins were different. A significant gap was observed when comparing the expected and observed statin indication, with few patients achieving the LDL-C goals.
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Affiliation(s)
- Walter Masson
- Servicio de Cardiología, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB Ciudad Autónoma de Buenos Aires, Argentina.
| | - Emiliano Rossi
- Servicio de Cardiología, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB Ciudad Autónoma de Buenos Aires, Argentina
| | - Rodolfo N Alvarado
- Servicio de Reumatología, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB Ciudad Autónoma de Buenos Aires, Argentina
| | - Guillermo Cornejo-Peña
- Servicio de Cardiología, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB Ciudad Autónoma de Buenos Aires, Argentina
| | - Juan I Damonte
- Servicio de Cardiología, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB Ciudad Autónoma de Buenos Aires, Argentina
| | - Norberto Fiorini
- Servicio de Cardiología, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB Ciudad Autónoma de Buenos Aires, Argentina
| | - Lorena M Mora-Crespo
- Servicio de Cardiología, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB Ciudad Autónoma de Buenos Aires, Argentina
| | - Mayra A Tobar-Jaramillo
- Servicio de Reumatología, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB Ciudad Autónoma de Buenos Aires, Argentina
| | - Marina Scolnik
- Servicio de Reumatología, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, C1199ABB Ciudad Autónoma de Buenos Aires, Argentina
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Durán J, Massardo L, Llanos C, Iacobelli S, Burgos PI, Cisternas M, Iruretagoyena M, Armstrong M, Aguilera R, Radrigán F, Martinez ME, Passi-Solar A, Riedemann P, Crisóstomo N, Cifuentes C, Hagedorn L, Cisternas A, Vasquez N, Margozzini P. The Prevalence of Rheumatoid Arthritis in Chile: A Nationwide Study Performed as Part of the National Health Survey. J Rheumatol 2020; 47:951-958. [PMID: 31474598 DOI: 10.3899/jrheum.190396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Genetic and environmental backgrounds influence the development of rheumatoid arthritis (RA). In Latin America, epidemiologic data are scarce. We aimed to determine the prevalence of RA in Chile in a population-based study. METHODS The National Health Survey was a cross-sectional household survey with a stratified multistage probability sample of 6233 participants performed between August 2016 and March 2017. A screening instrument for RA was applied to a random sample of 3847 subjects > 30 years old. Positive screening was defined by at least 1 of the following: 2 swollen joints for at least 4 consecutive weeks (past/present), and/or a diagnosis of arthritis in the past. Individuals with positive screening had rheumatoid factor, anticitrullinated protein antibodies, and C-reactive protein measured, as well as clinical examination performed by a rheumatologist. Self-report of doctor-diagnosed RA was also performed. RESULTS The screening questionnaire was applied to 2998 subjects. A positive screening was found for 783 (22.1%). Among subjects with positive screening, 493 (66%) had a clinical evaluation performed by a rheumatologist. Using the American College of Rheumatology/European League Against Rheumatism 2010 classification criteria, prevalence was 0.6% (95% CI 0.3-1.2). Prevalence was higher in women, and 3.3% of subjects self-reported having RA. CONCLUSION According to this national population-based study, RA prevalence in Chile is 0.6% (0.3-1.2), a value similar to what has been found in developed countries and slightly lower than some Latin American countries. Self-reporting leads to overestimating RA.
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Packer M. Link Between Synovial and Myocardial Inflammation: Conceptual Framework to Explain the Pathogenesis of Heart Failure with Preserved Ejection Fraction in Patients with Systemic Rheumatic Diseases. Card Fail Rev 2020. [DOI: 10.15420/cfr.2019.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Patients with a broad range of systemic rheumatic diseases are at increased risk of heart failure (HF), an event that is not related to traditional cardiovascular risk factors or underlying ischaemic heart disease. The magnitude of risk is linked to the severity of arthritic activity, and HF is typically accompanied by a preserved ejection fraction. Subclinical evidence for myocardial fibrosis, microcirculatory dysfunction and elevated cardiac filling pressures is present in a large proportion of patients with rheumatic diseases, particularly those with meaningful systemic inflammation. Drugs that act to attenuate pro-inflammatory pathways (methotrexate and antagonists of tumour necrosis factor and interleukin-1) may ameliorate myocardial inflammation and cardiac structural abnormalities and reduce the risk of HF events.
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Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, US and Imperial College, London, UK
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Experience of a Performance-Based Risk-Sharing Arrangement for the Treatment of Rheumatoid Arthritis With Certolizumab Pegol. Value Health Reg Issues 2020; 21:201-204. [PMID: 32199257 DOI: 10.1016/j.vhri.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 10/15/2019] [Accepted: 01/06/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To describe the process and results of the implementation of a performance-based risk-sharing arrangement for the use of certolizumab pegol (Cimzia) in patients with rheumatoid arthritis (RA), based on rational pharmacotherapy. METHODS In 2014, the area of Management of Drugs and Supplies of the health maintenance organization of the Hospital Italiano de Buenos Aires signed a performance-based risk-sharing arrangement with Montpellier Laboratory for the use of certolizumab pegol in patients with RA. The laboratory would reimburse the hospital the cost of the first 10 doses of the drug if an optimal clinical response was not achieved (difference greater than or equal to 1.2 in the Disease Activity Score 28 with erythrocyte sedimentation [Δ DAS28 ESR] measured at the beginning and at the end), or if the patient presented with an adverse drug reaction, during the first 12 weeks of treatment. RESULTS Forty patients with RA were included between September 2014 and January 2018. Thirty-six patients completed 12 weeks of treatment, of which 25 (69.4 %) had an optimal clinical response (Δ DAS28 ESR ≥ 1.2). The laboratory reimbursed the hospital 116 doses of certolizumab pegol, corresponding to 12 patients (12 of 40, 30%). Eleven of them did not reach the optimal clinical response, and 1 presented with an adverse drug reaction. CONCLUSIONS The performance-based risk-sharing arrangement proved to be a useful tool to optimize the resources of the healthcare payer and contributed to the collection of scientific evidence in real-life patients.
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Evaluation of Learned Helplessness, Perceived Self-efficacy, and Functional Capacity in Patients With Fibromyalgia and Rheumatoid Arthritis. J Clin Rheumatol 2019; 25:65-68. [PMID: 29620593 DOI: 10.1097/rhu.0000000000000769] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The aims of this study were to compare learned helplessness (LH) and perceived self-efficacy (SE) in patients with fibromyalgia (FM) and rheumatoid arthritis (RA) and to assess their correlation with functional disability, level of perceived pain, and fatigue. METHODS This multicenter, cross-sectional study included consecutive patients (aged ≥18 years) with RA, according to the 2010 American College of Rheumatology/European League Against Rheumatism criteria, and FM, according to 2010 American College of Rheumatology criteria. Learned helplessness was measured by the Rheumatology Attitude Index, Spanish version; SE with the Arthritis Self-efficacy Scale, Spanish version; functional capacity with the Health Assessment Questionnaire (HAQ), Argentine version; depression with Center for Epidemiological Studies-Depression Scale 7-item version and perceived pain and fatigue by the visual analog scale. Disease activity was measured by the Clinical Disease Activity Index (CDAI) and disease impact with the Fibromyalgia Impact Questionnaire (FIQ). RESULTS A total of 215 patients, 100 with FM and 115 with RA, were included. Mean age was 59 (SD, 14) years and 58 (SD, 13) years for FM and RA, patients respectively. Whereas LH and depression were significantly higher, SE was significantly lower in FM patients. We found a positive correlation between LH and HAQ, pain, depression, fatigue, FIQ, and CDAI in FM and RA patients. We observed a negative correlation between SE and HAQ, pain, depression, fatigue, FIQ (FM), and CDAI (RA) in both groups. CONCLUSIONS Both LH and SE correlate significantly with functional capacity, perceived pain, disease activity, and disease impact in RA and FM patients. Learned helplessness was higher in patients with active disease or high disease impact, as opposed to those in remission or with low disease impact, and the reverse was true for SE. Patients with FM had significantly more LH, pain, fatigue, and depression and less SE compared with those with RA.
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Gong X, Xu SQ, Tong H, Wang XR, Zong HX, Pan MJ, Ten YZ, Xu JH, Wei W. Correlation between systemic osteoporosis and local bone erosion with rheumatoid arthritis patients in Chinese population. Rheumatology (Oxford) 2019:kez042. [PMID: 30847477 DOI: 10.1093/rheumatology/kez042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/22/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE RA is a systemic auto-immune inflammatory disease that can lead to local bone erosions and generalized osteoporosis (OP). The aim of this study was to investigate the relationship between systemic osteoporosis and local bone erosion with RA patients in the Chinese population. METHODS In total, 1235 patients with RA and 158 normal subjects were enrolled in this study. Clinical and laboratory features were recorded in detail. Information about functional class and physical activity was collected using specific questionnaires. Dual-energy X-ray absorptiometry was used to measure BMD. The MECALL castor-50-hf model X-ray scanner was used for two-hand (including wrist) photographs. RESULTS The median Sharp scores differed significantly between the normal bone mass group, osteopenia group and OP group (P < 0.001). There was a modest negative linear correlation between Sharp and HAQ scores and longer disease duration (P < 0.001). There was a clear increasing trend in Sharp score, incidence of OP and HAQ score in the different DAS in 28 joints (DAS28) activity groups (P < 0.001). Spearman's correlation test showed that Sharp and HAQ scores were negatively correlated with BMD at all measured sites (femoral neck, total hip and L1-4) (P < 0.001). Logistic regression indicated that age, female gender, and Sharp and HAQ scores were independent risk factors in the occurrence of OP in RA patients. The use of DMARDs and BMI were protective factors for OP. CONCLUSION These results suggest that BMD is associated with local bone erosion among Chinese patients with RA. Local bone erosion is closely related to clinical symptoms and BMD in patients with RA.
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Affiliation(s)
- Xun Gong
- Institute of Clinical pharmacology, Anhui Medical University
| | - Sheng-Qian Xu
- Department of Rheumatology & Immunology, The First Affiliated Hospital of Anhui Medical University
| | - Hui Tong
- Department of Rheumatology & Immunology, The First Affiliated Hospital of Anhui Medical University
| | - Xin-Rong Wang
- Department of Rheumatology & Immunology, The First Affiliated Hospital of Anhui Medical University
| | - He-Xiang Zong
- Department of Rheumatology & Immunology, The First Affiliated Hospital of Anhui Medical University
| | - Mei-Juan Pan
- Department of Rheumatology & Immunology, The First Affiliated Hospital of Anhui Medical University
| | - Yu-Zhu Ten
- Department of Rheumatology & Immunology, The First Affiliated Hospital of Anhui Medical University
| | - Jia-Hua Xu
- Department of Rheumatology & Immunology, The First Affiliated Hospital of Anhui Medical University
| | - Wei Wei
- Institute of Clinical pharmacology, Anhui Medical University
- Key Laboratory of Anti-Inflammatory and Immune Medicine, Ministry of Education
- Anhui Collaborative Innovation Centre of Anti-Inflammatory and Immune Medicine, Hefei, China
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Pierini FS, Scolnik M, Scaglioni V, Mollerach F, Soriano ER. Incidence and prevalence of granulomatosis with polyangiitis and microscopic polyangiitis in health management organization in Argentina: a 15-year study. Clin Rheumatol 2019; 38:1935-1940. [DOI: 10.1007/s10067-019-04463-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 10/27/2022]
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Muilu P, Rantalaiho V, Kautiainen H, Virta LJ, Eriksson JG, Puolakka K. Increasing incidence and shifting profile of idiopathic inflammatory rheumatic diseases in adults during this millennium. Clin Rheumatol 2018; 38:555-562. [PMID: 30259249 DOI: 10.1007/s10067-018-4310-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/12/2018] [Accepted: 09/20/2018] [Indexed: 02/08/2023]
Abstract
To explore the trends in the incidence of idiopathic inflammatory rheumatic diseases (IIRDs) after the turn of the millennium. From a nationwide register maintained by the Social Insurance Institution of Finland, we collected all adult patients with IIRDs granted a new special reimbursement for anti-rheumatic drugs between 2000 and 2014. Temporal trends in the incidences of various IIRDs were estimated in three 5-year intervals. A total of 58,405 adult patients were identified. Between 2000-2004 and 2010-2014, the age-adjusted incidence rate of IIRDs increased from 114 to 116/100000 [incidence rate ratio (IRR) 1.03 (95% CI 1.01 to 1.06)] in women and from 67 to 69/100,000 [IRR 1.10 (95% CI 1.06-1.14)] in men. The incidence of seropositive rheumatoid arthritis (RA) remained stable while that of seronegative RA decreased. For other diagnoses, the incidences either increased (unspecified arthritis, psoriatic arthritis, spondyloarthritis), remained stable (reactive arthritis), or decreased (SLE and the group of diseases with the ICD-10 code M35). The gender difference in spondyloarthritis leveled as the incidence in women increased at a higher rate than in men. Mean age at IIRD diagnosis decreased among women. The total age-adjusted incidence of IIRDs has gradually increased, due to the increase in unspecified arthritis, psoriatic arthritis, and spondyloarthritis. This, in addition to the ascending number of individuals at risk in the population, translates into a growing burden to the health care system.
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Affiliation(s)
- Paula Muilu
- Department of Medicine, Tampere University Hospital, PL 2000, 33521, Tampere, Finland.
| | - Vappu Rantalaiho
- Centre for Rheumatic Diseases, Tampere University Hospital, Arvo Ylponkatu 6, 33520, Tampere, Finland.,Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki, PL 20, 00014, Helsinki, Finland.,Unit of Primary Health Care, Turku University Hospital, Turku, Finland
| | - Lauri Juhani Virta
- Research Department, Social Insurance Institution of Finland, PL 450, 00056, Turku, Finland
| | - Johan Gunnar Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki, PL 20, 00014, Helsinki, Finland.,Folkhälsan Research Center, Helsinki, Finland
| | - Kari Puolakka
- Department of Medicine, South Karelia Central Hospital, Valto Kakelankatu 3, 53130, Lappeenranta, Finland
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Elevated serum 14-3-3η protein may be helpful for diagnosis of early rheumatoid arthritis associated with secondary osteoporosis in Chinese population. Clin Rheumatol 2017; 36:2581-2587. [PMID: 28875246 DOI: 10.1007/s10067-017-3807-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/08/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
Abstract
Osteoporosis (OP) is one of the signs of bone damage in rheumatoid arthritis (RA). The 14-3-3η protein is an inflammatory protein, which has been reported to be associated with rheumatoid arthritis (RA). This is to determine the serum levels of 14-3-3η protein, evaluate its diagnostic value in early RA, and clear out its significance in RA with secondary osteoporosis. Two hundred fifty-nine RA patients and 80 age and sex-matched healthy controls were included. Assays of serum 14-3-3η protein were done for all participants by enzyme-linked immunosorbent assay (ELISA). Dual-energy X-ray absorptiometry (DEXA) was used to measure bone mineral density (BMD). Serum 14-3-3η protein level was significantly high in RA (2.49/4.72), compared with controls (P < 0.0001). Positive rate of 14-3-3η protein in RA was 97.3%, which was higher than that in controls (χ 2 = 276.641, P < 0.0001). Serum 14-3-3η protein level in early RA was significantly higher than that in established RA (3.91/4.82 vs 2.01/3.29, Z = 2.624, P < 0.05). The positive rate among three groups (normal control, early RA group, established RA group) differed from each other (χ 2 = 131.396, P < 0.0001). Results of ROC curve indicated the cutoff point of 14-3-3η protein for diagnosis of early RA was 0.879 ng/ml (P < 0.0001). Linear correlation analysis found that serum 14-3-3η protein positively correlated with VAS and HAQ (P < 0.0001), negatively correlated with BMD at lumbar spine and femur in RA (P < 0.0001). Serum 14-3-3η protein among groups of bone mass normal (2.73/3.79), osteopenia (3.15/4.86), and osteoporosis (6.34/6.42) was different in early RA patients (χ 2 = 7.974, P < 0.05). Serum 14-3-3η protein levels increase significantly in patients with RA (especially in early RA). There are close relationships between serum 14-3-3η protein and clinical symptoms and osteoporosis in patients with RA.
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SCUBLINSKY DARIO, GONZALEZ CLAUDIOD. Quantifying Disease in Challenging Conditions: Incidence and Prevalence of Rheumatoid Arthritis. J Rheumatol 2016; 43:1263-4. [DOI: 10.3899/jrheum.160522] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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