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Abstract
BackgroundThere 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.MethodsThe 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.ResultsA 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.ConclusionsThe 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.
Highlights
There are few data on the epidemiology, clinical manifestations and management of Rheumatoid arthritis (RA) in Brazil, even with the recognition of the high direct, indirect and societal costs of this disease
The general demographic and clinical data of the population at the time of the initial evaluation are presented in Tables 3 and 4
The majority of subjects were white, with minorities from Asian and Brazilian-Indian origins making up 1% of the sample
Summary
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. The availability of new therapeutic options, mainly the biologic agents, and the adoption of a treat-to-target strategy have been of utmost importance for improving patient outcomes [3]. Despite all this progress, in many areas of the world, the diagnosis of RA is delayed and patients remain undertreated, resulting in great negative humanistic and socioeconomic impact [4, 5]. A better understanding of the profile of RA patients seen in public health care centers in Brazil can underpin public health policy, enabling a rational allocation of resources and the setting of priorities in this sector
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