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Bonfiglioli KR, de Medeiros Ribeiro AC, Carnieletto AP, Pereira I, Domiciano DS, da Silva HC, Pugliesi A, Pereira LR, Guimarães MFR, Giorgi RDN, Reis APMG, Brenol CV, Louzada-Júnior P, da Cunha Sauma MDFL, Radominski SC, da Mota LMH, da Rocha Castelar-Pinheiro G. Extra-articular manifestations of rheumatoid arthritis remain a major challenge: data from a large, multi-centric cohort. Adv Rheumatol 2023; 63:34. [PMID: 37496102 DOI: 10.1186/s42358-023-00318-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 07/19/2023] [Indexed: 07/28/2023] Open
Abstract
INTRODUCTION Although Rheumatoid Arthritis (RA) extra-articular manifestations (ExtRA) occurrence has been decreasing over time, they are still a major mortality risk factor for patients. OBJECTIVE To determine the prevalence of ExtRA in a large cohort, and its association with demographic and clinical variables. METHOD Cross-sectional and observational study, based on a multi-centric database from a prospective cohort, in which 11 public rheumatology centres enrolled RA patients (1987 ARA or 2010 ACR-EULAR). Data collection began in 08-2015, using a single online electronic medical record. Continuous variables were compared using Mann-Whitney U-test, and Fisher's exact test or chi-square test, as appropriate, were used for categorical variables. The level of significance was set at 5% (p < 0.05). RESULTS 1115 patients were included: 89% women, age [mean ± SD] 58.2 ± 11.5 years, disease duration 14.5 ± 12.2 years, positive Rheumatoid Factor (RF, n = 1108) in 77%, positive anti-cyclic citrullinated peptide (ACPA, n = 477) in 78%. Regarding ExtRA, 334 occurrences were registered in 261 patients, resulting in an overall prevalence of 23.4% in the cohort. The comparison among ExtRA and Non-ExtRA groups shows significant higher age (p < 0.001), disease duration (p < 0.001), RF high titers (p = 0.018), Clinical Disease Activity index (CDAI) (p < 0.001), Disease Activity Index 28 (DAS 28) (p < 0.001), and Health Assessment Questionnaire (HAQ) (p < 0.001) in ExtRA group. Treatment with Azathioprine (p = 0.002), Etanercept (p = 0.049) Glucocorticoids (GC) ('p = 0.002), and non-steroidal anti-inflammatory drugs (NSAIDs) (p < 0.001) were more frequent in ExtRA group. CONCLUSIONS ExtRA manifestations still show an expressive occurrence that should not be underestimated. Our findings reinforce that long-term seropositive disease, associated with significant disability and persistent inflammatory activity are the key factors related to ExtRA development.
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Affiliation(s)
- Karina Rossi Bonfiglioli
- Serviço de Reumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Av.Dr. Arnaldo, 455 - 3º andar - Reumatologia, São Paulo, SP, 01246-903, Brazil.
| | - Ana Cristina de Medeiros Ribeiro
- Serviço de Reumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Av.Dr. Arnaldo, 455 - 3º andar - Reumatologia, São Paulo, SP, 01246-903, Brazil
| | | | - Ivânio Pereira
- Serviço de Reumatologia do Hospital Universitário da Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
| | - Diogo Souza Domiciano
- Serviço de Reumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Av.Dr. Arnaldo, 455 - 3º andar - Reumatologia, São Paulo, SP, 01246-903, Brazil
| | - Henrique Carriço da Silva
- Serviço de Reumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Av.Dr. Arnaldo, 455 - 3º andar - Reumatologia, São Paulo, SP, 01246-903, Brazil
| | - Alisson Pugliesi
- Disciplina de Reumatologia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
| | - Leticia Rocha Pereira
- Serviço de Reumatologia da Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | | | - Rina Dalva Neubarth Giorgi
- Serviço de Reumatologia do Hospital do Servidor Público Estadual de São Paulo (HSPE-IAMSPE), São Paulo, Brazil
| | | | - Claiton Viegas Brenol
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (HCPA/UFRGS), Porto Alegre, Brazil
| | - Paulo Louzada-Júnior
- Disciplina de Reumatologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP-RP), São Paulo, Brazil
| | | | - Sebastião Cezar Radominski
- Disciplina de Reumatologia, Faculdade de Medicina da Universidade Federal do Paraná (UFPR), Curitiba, Brazil
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Ramon Haddad PA, Vargas-Santos AB, Silva Freire Coutinho E, Rocha Pereira L, Henrique da Mota LM, Pires de Albuquerque C, Brandão de Resende Guimarães MF, Louzada-Júnior P, Rossi Bonfiglioli K, de Carvalho Sacilotto N, Radominski SC, Aliel Vigano Pugliesi A, Lobato da Cunha Sauma MDF, Alves Pereira I, Viegas Brenol C, da Rocha Castelar-Pinheiro G. Performance of the Rheumatoid Arthritis Disease Activity Index in the Assessment of Disease Activity in Rheumatoid Arthritis-Findings From the REAL Study. J Clin Rheumatol 2022; 28:206-211. [PMID: 35319537 DOI: 10.1097/rhu.0000000000001834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVE Although telemedicine use has been under discussion for decades, this topic has gained unprecedented importance during the COVID-19 pandemic. The Rheumatoid Arthritis Disease Activity Index (RADAI) is a user-friendly tool, fully self-administered, to assess rheumatoid arthritis (RA) disease activity. The aim of this study was to compare the performance of RADAI with other disease activity indices, functional status, and inflammatory markers in a large cohort of RA patients. METHODS We assessed the concurrent validity of RADAI against Clinical Disease Activity Index (CDAI), Disease Activity Score in 28 Joints-C-reactive protein, Disease Activity Score in 28 Joints-erythrocyte sedimentation rate, Simplified Disease Activity Index, and physician assessment of disease activity and the correlation of RADAI with Health Assessment Questionnaire-Disability Index and inflammatory markers at the REAL Study baseline. We also evaluated the correlation of the change in RADAI and the change in CDAI over a 6-month follow-up. RESULTS From the 1115 patients included in the REAL Study, 1113 had RADAI scores in the first assessment. At baseline, correlations between RADAI and other disease activity indices were strong, ranging from 0.64 (comparison with physician assessment) to 0.79 (comparison with CDAI). Correlation between the change in RADAI score over the 6 months of follow-up and the change in CDAI score over the same period was moderate/strong for the overall group and within the stratified analyses. CONCLUSION The strong correlation of RADAI with other well-established tools for disease activity measurement reassures its use with RA patients' follow-up, especially in this new era of telemedicine.
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Affiliation(s)
| | | | | | - Leticia Rocha Pereira
- Institute of Social Medicine, Department of Epidemiology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro
| | | | | | | | - Paulo Louzada-Júnior
- Disciplina de Reumatologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto
| | - Karina Rossi Bonfiglioli
- Disciplina de Reumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
| | - Nathália de Carvalho Sacilotto
- Serviço de Reumatologia, Hospital do Servidor Público Estadual de São Paulo, Instituto de Assistência Médica ao Servidor Público Estadual, São Paulo
| | | | | | | | | | - Claiton Viegas Brenol
- Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre
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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: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Gomides APM, de Albuquerque CP, Santos ABV, Bértolo MB, Júnior PL, Giorgi RDN, Radominski SC, Resende Guimarães MFB, Bonfiglioli KR, de Fátima Lobato da Cunha Sauma M, Pereira IA, Brenol CV, da Mota LMH, Pinheiro GDRC. Real-life data of survival and reasons for discontinuation of biological disease-modifying drugs 'in' rheumatoid arthritis. Int J Clin Pharm 2020; 43:737-742. [PMID: 33085040 DOI: 10.1007/s11096-020-01171-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 10/06/2020] [Indexed: 11/29/2022]
Abstract
Background Rheumatoid arthritis is a chronic, autoimmune disease in which treatment has evolved with a variety of therapeutic classes. Biological disease-modifying antirheumatic drugs have improved therapy; however, the continued long-term use of these drugs with sustained safety and efficacy remains a challenge. ObjectiveThe objective of this study was to analyze time of use and reasons for discontinuation of biological disease-modifying antirheumatic drugs in patients with rheumatoid arthritis.SettingIt is as part of REAL (Rheumatoid Arthritis in Real Life), a multicenter project that evaluated Brazilian patients with rheumatoid arthritis in a real-life setting. Eleven referral centers for the treatment in the public network participated in the study.MethodsWe conducted a cross-sectional analysis of data collected in the REAL study from August to October 2015 study. The patients were submitted to clinical evaluation and analysis of medical records.Results1125 patients were included (89.5% women; median age: 56.6 years; and disease time: 12.8 years). A total of 406 (36.09%) participants were on a biological disease-modifying antirheumatic drugs. Infliximab was the drug with the longest time of use (12 years). Most (64.4%) drug suspension episodes were due to inefficacy. Adalimumab and certolizumab had a greater number of suspensions due to primary inefficacy, while discontinuations for abatacept were due more to secondary inefficacy. Infliximab had fewer suspensions due to primary inefficacy and golimumab had fewer episodes of secondary inefficacy. Regarding side effects, infliximab was suspended a greater number of times because of clinical and laboratory side effects. Abatacept and adalimumab had fewer suspensions due to clinical side effects, and certolizumab, rituximab and tocilizumab had fewer laboratory adverse effects. Conclusion Among the biological disease-modifying antirheumatic drugs being used for long periods, infliximab had greater time of use. Most drug suspensions (64%) were due to primary or secondary inefficacy. Number of discontinuations due to clinical and laboratory adverse effects for each drug was analyzed, and these data should be confirmed by other real-life studies. Knowledge of what is happening in real life is essential to health professionals, who need to be aware of the most common adverse effects and to health managers, who aim for greater cost-effectiveness in the choice of medications.
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Affiliation(s)
| | | | | | | | - Paulo Louzada Júnior
- Faculdade de Medicina da, Universidade de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, 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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Sacilotto NDC, Giorgi RDN, Vargas-Santos AB, de Albuquerque CP, Radominski SC, Pereira IA, Guimarães MFBR, Bértolo MB, Louzada P, Sauma MDFLDC, Bonfiglioli KR, Brenol CV, da Mota LMH, Castelar-Pinheiro GDR. Real - rheumatoid arthritis in real life - study cohort: a sociodemographic profile of rheumatoid arthritis in Brazil. Adv Rheumatol 2020; 60:20. [PMID: 32171331 DOI: 10.1186/s42358-020-0121-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 02/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Brazil, socioeconomic differences in the incidence of rheumatoid arthritis (RA) have been demonstrated, which are important in the formulation of hypotheses regarding the association between environmental factors, lifestyle and the risk of disease development. This study examines how the socioeconomic condition of the patient with RA in Brazil, assessed according to social class, educational level, employment situation and use of caregivers, affects the times between the beginning of symptoms and diagnosis and the beginning of the use of disease-modifying antirheumatic drugs, as well as the presence of erosive disease and functional status. METHODS This work is part of a multicentric study called REAL - Rheumatoid Arthritis in Real Life in Brazil, which is a prospective observational cohort study. RESULTS As described in the REAL study, we included a total of 1115 patients. It was noted that patients with an educational classification of up to second grade incomplete presented with erosion percentages above those with a higher grade complete. Patients with caregivers presented a higher percentage of erosion than patients without caregivers. We verified that patients from economic classes above B2 presented fewer occurrences of erosion than those from classes C2, D-E. We also analyzed the average time differences from the beginning of symptoms and diagnosis and the beginning of treatment, according to academic level, erosion and economic classification. Patients with first grade complete showed an HAQ-DI averages higher than those with second grade complete. The patients who had employment showed lower HAQ-DI averages than patients who were not employed. The patients with erosion showed an HAQ-DI value higher than those without erosion. Patients with caregivers showed an HAQ-DI average higher than that of without caregivers. CONCLUSION This study showed that the therapeutic window of RA is not being reached, and therefore we should have a policy to expand and ensure access to public health for all patients, especially those with lower levels of education and income. TRIAL REGISTRATION This study was approved by the National Commission of Ethics in Research.
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Affiliation(s)
- Nathália de Carvalho Sacilotto
- Hospital do ServidorPúblicoEstadual de São Paulo, Rua Pedro de Toledo, 1800, Vila Clementino, São Paulo, SP, 04039-000, Brazil.
| | - Rina Dalva Neubarth Giorgi
- Hospital do ServidorPúblicoEstadual de São Paulo, Rua Pedro de Toledo, 1800, Vila Clementino, São Paulo, SP, 04039-000, Brazil
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Gomides APM, de Albuquerque CP, Santos ABV, Bértolo MB, Júnior PL, Giorgi RDN, Radominski SC, Resende Guimarães MFB, Bonfiglioli KR, de Fátima Lobato da Cunha Sauma M, Pereira IA, Brenol CV, da Mota LMH, da Rocha Castelar Pinheiro G. Rheumatoid artrhitis treatment in Brazil: data from a large real-life multicenter study. Adv Rheumatol 2020; 60:16. [PMID: 32106881 DOI: 10.1186/s42358-020-0119-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 02/17/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Last decades witnessed great technological advances in rheumatoid arthritis (RA) management, but their implementation in clinical practice might prove difficult. Despite the efficacy demonstrated in controlled trials this information needs to be confirmed by real life data. This study assessed real-life treatment among RA patients. METHODS REAL study included Brazilian RA patients from eleven centers. Interview and medical records were performed. Continuous variables were compared using Student's t or Mann-Whitney and categorical variables were assessed with chi-square or Fisher's exact tests. RESULTS 1115 patients were included, women 89.5%. Median age 56.6 years, disease duration 152.5 months; 78.7% were rheumatoid fator positive; 55.2% had erosive disease; DAS28 (disease activity index-28 joints) = 3.5, HAQ (health assessment questionnaire) =0.875. The median duration of symptoms until the start of first DMARD was 12 months. A total of 529 (47.2%) patients used corticosteroids; 1022 (90.8%) were on conventional synthetic (cs) DMARDs and 406 (36.1%) on biological (b) DMARDs. Methotrexate (MTX) was the most frequent csDMARD: 748 (66.5%) patients, followed by leflunomide (LFN), used by 381 (33.9%) of patients. MTX was associated to LFN in 142 (12.6%) patients. Only five (0.4%) patients used triple therapy (MTX + hydroxychloroquine + sulfasalazine) or sulfasalazine in monotherapy. CONCLUSIONS Despite advances in therapeutic resources, roughly half RA patients failed achieve T2T goals and 55.2% developed erosive disease. The frequent use of corticosteroids and delay in initiating DMARDs were demonstrated. Issues concerning timely access to medical care are crucial for effective management.
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Affiliation(s)
| | | | | | | | - Paulo Louzada Júnior
- Faculdade de Medicina da Universidade de Ribeirao Preto, Universidade de Sao Paulo, Ribeirão Preto, 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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Gomides APM, de Albuquerque CP, Santos ABV, Amorim RBC, Bértolo MB, Júnior PL, Santos IA, Giorgi RDN, Sacilotto NDC, Radominski SC, Borghi FM, Guimarães MFBR, Pinto MRDC, Resende GG, Bonfiglioli KR, da Silva HC, Sauma MDFLDC, Sauma ML, de Medeiros JB, Pereira IA, de Castro GRW, Brenol CV, Xavier RM, da Mota LMH, Pinheiro GDRC. Causes of synthetic disease-modifying drug discontinuation in rheumatoid arthritis: Data from a large real-life cohort. PLoS One 2019; 14:e0213219. [PMID: 30822348 PMCID: PMC6396919 DOI: 10.1371/journal.pone.0213219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 02/15/2019] [Indexed: 02/07/2023] Open
Abstract
The treatment of rheumatoid arthritis (RA) has evolved rapidly in recent years. Nonetheless, conventional synthetic disease-modifying drugs (csDMARDs) remain the gold standard for RA treatment. The treatment for RA is expensive and this has a negative impact on public health. Given the low cost of csDMARDs compared to those of other treatment strategies, it is important to manage this type of treatment properly. Information on the duration of use of each drug and the reasons for their discontinuation is relevant to medical practitioners as it could improve the information available regarding side effects and their proper management. Moreover, data from clinical practice in the population can provide health care managers with information for resource allocation and optimization of csDMARD use with a consequent cost reduction in the treatment of RA. In this cross-sectional study, we aimed to describe the use of csDMARDs in public health services in Brazil, emphasizing on the duration of use and reasons for discontinuation of each drug. This study is a part of the REAL, a multicenter project that evaluated Brazilian patients with RA from eleven rheumatology services from August to October 2015. Patients were examined clinically, and an analysis of complementary exams and medical records was performed. A total of 1125 patients were included. 98.5% were women with a median age of 55.6 years. 36% and 90.84% patients were using biological disease-modifying drugs (bDMARDs) and csDMARDs, respectively. The duration of use and doses of each medication and the causes of suspension were analyzed. Most of the patients analyzed in this study were using csDMARDs for prolonged periods and methotrexate showed the longest duration of use. Interruption indexes due to ineffectiveness and side effects were analyzed. The knowledge of common adverse effects may alert attending physicians to the proper management of effective and low-cost therapeutic groups.
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Affiliation(s)
- Ana Paula Monteiro Gomides
- Departamento de Reumatologia, Universidade de Brasília, Brasília, Distrito Federal, Brazil
- Departamento do curso de Medicina, Centro Universitário de Brasília- Uniceub, Brasília, Distrito Federal, Brazil
- * E-mail:
| | | | - Ana Beatriz Vargas Santos
- Departamento de Reumatologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Manoel Barros Bértolo
- Departamento de Reumatologia, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil
| | - Paulo Louzada Júnior
- Departamento de Reumatologia, Faculdade de Medicina da Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Isabela Araújo Santos
- Departamento de Reumatologia, Faculdade de Medicina da Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Rina Dalva Neubarth Giorgi
- Departamento de Reumatologia, Instituto de Assistência Médica ao Servidor Público Estadual, Hospital do Servidor Público Estadual de São Paulo, São Paulo, São Paulo, Brazil
| | - Nathalia de Carvalho Sacilotto
- Departamento de Reumatologia, Instituto de Assistência Médica ao Servidor Público Estadual, Hospital do Servidor Público Estadual de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Fernanda Maria Borghi
- Departamento de Reumatologia, Universidade Estadual de Maringá, Maringá, Paraná, Brazil
| | | | | | - Gustavo Gomes Resende
- Departamento de Reumatologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | | | - Marcel Lobato Sauma
- Departamento de Reumatologia, Universidade Federal do Pará, Belém, Pará, Brazil
| | | | - Ivânio Alves Pereira
- Departamento de Reumatologia, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | | | - Claiton Viegas Brenol
- Departamento de Reumatologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Ricardo Machado Xavier
- Departamento de Reumatologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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da Rocha Castelar-Pinheiro G, Vargas-Santos AB, de Albuquerque CP, Bértolo MB, Júnior PL, Giorgi RDN, Radominski SC, Resende Guimarães MFB, Bonfiglioli KR, Sauma MDFLDC, Pereira IA, Brenol CV, Coutinho ESF, da Mota LMH. The REAL study: a nationwide prospective study of rheumatoid arthritis in Brazil. Adv Rheumatol 2018; 58:9. [PMID: 30657089 DOI: 10.1186/s42358-018-0017-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/15/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There are few data on the epidemiology, clinical manifestations and management of RA in Brazil, even with the recognition of the high direct, indirect and societal costs of this disease. Herein, we report the formation of the REAL - Rheumatoid Arthritis in Real Life, the first nationally representative multicenter prospective observational study in Brazil. METHODS The REAL study was designed to include a total of 1300 evaluable patients from 13 tertiary care public health centers specialized in RA management and representative of 5 regions of Brazil. Each center was expected to enroll ~ 100 consecutively seen patients and follow them prospectively in a systematic protocol-driven fashion with scheduled visits at baseline, 6 and 12 months. Core clinical, laboratory and patient-reported outcomes measures were required to be collected at each visit. RESULTS A total of 1115 patients (89.4% female, mean age of 56.7 years and median disease duration of 12.7 years) were enrolled from 11 participating centers. Almost 80% of patients were of middle-low or low socioeconomic classes. The median educational time was 8 years, with 3.23% being below literacy level. The interval between symptoms and diagnosis varied from 1 to 457 months (median 12 months). Almost half of the patients were on glucocorticoids, 96.5% on DMARDs, with 35.7% on biologics. Median HAQ-DI was 0.875, ranging from 0 to 3. Median DAS28-ESR was 3.5, with 58.7% of patients presenting moderate or high disease activity. CONCLUSIONS The first large cohort of Brazilian patients with RA in a real-life setting shows several striking differences from previously published cohorts from other countries. The long delay for diagnosis and start of DMARDs may partly explain the high frequency of erosive disease. An elevated percentage of patients on moderate or high disease activity was seen, despite of the high frequency of corticosteroid and biologics utilization. Data from this cohort may enable public health managers of developing countries better allocate the limited resources available for the care of RA patients.
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Affiliation(s)
- Geraldo da Rocha Castelar-Pinheiro
- Departamento de Medicina Interna, Disciplina de Reumatologia, Universidade do Estado do Rio de Janeiro, Avenida Nossa Senhora de Copacabana, 978, sala 508, Copacabana, Rio de Janeiro, RJ, 22060-002, Brazil.
| | - Ana Beatriz Vargas-Santos
- Serviço de Reumatologia, Hospital Universitário Pedro Ernesto - Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Manoel Barros Bértolo
- Disciplina de Reumatologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, Brazil
| | - Paulo Louzada Júnior
- Disciplina de Reumatologia, Faculdade de Medicina da Universidade de Ribeirao Preto, Universidade de Sao Paulo, Ribeirão Preto, Brazil
| | - Rina Dalva Neubarth Giorgi
- Serviço de Reumatologia, Instituto de Assistência Médica ao Servidor Público Estadual, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil
| | - Sebastião Cezar Radominski
- Disciplina de Reumatologia, Faculdade de Medicina da Universidade Federal do Paraná, Universidade Federal do Paraná, Curitiba, Brazil
| | | | | | | | - Ivânio Alves Pereira
- Serviço de Reumatologia, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Claiton Viegas Brenol
- Serviço de Reumatologia, Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Klumb EM, Silva CAA, Lanna CCD, Sato EI, Borba EF, Brenol JCT, Albuquerque EMDND, Monticielo OA, Costallat LTL, Latorre LC, Sauma MDFLDC, Bonfá ESDDO, Ribeiro FM. Consenso da Sociedade Brasileira de Reumatologia para o diagnóstico, manejo e tratamento da nefrite lúpica. Revista Brasileira de Reumatologia 2015; 55:1-21. [DOI: 10.1016/j.rbr.2014.09.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 09/14/2014] [Indexed: 12/29/2022] Open
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Sampaio-Barros PD, Zimmermann AF, Souza Müller CD, Lobato Borges CT, Medeiros Freire EA, Maretti GB, Marques Neto JF, Fonseca Salgado MC, da Cunha Sauma MDFL, de Azevedo MNL, Fontenelle S, Kayser C. Recomendações sobre diagnóstico e tratamento da esclerose sistêmica. Revista Brasileira de Reumatologia 2013. [DOI: 10.1590/s0482-50042013000300004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Sampaio-Barros PD, Zimmermann AF, Müller CDS, Borges CTL, Freire EAM, Maretti GB, Marques Neto JF, Salgado MCF, Sauma MDFLDC, de Azevedo MNL, Fontenelle S, Kayser C. Recommendations for the management and treatment of systemic sclerosis. Rev Bras Reumatol 2013; 53:258-275. [PMID: 24051909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
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Sauma MDFLDC, Nunes NAC, Lopes LFDM. Estudo retrospectivo das manifestações mlínicas e laboratoriais de 104 pacientes com Lúpus Eritematoso Sistêmico (LES), em Belém, PA, Brasil (1990-1999). Rev Bras Reumatol 2004. [DOI: 10.1590/s0482-50042004000300003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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