Arthritis In Colombia Research Articles

Prevalence and demographic characteristics of psoriatic arthritis in Colombia: Data from the National Health Registry 2012–2018

IntroductionPsoriatic arthritis is an inflammatory arthritis with a wide range of manifestations. The complexity of the disease is a barrier to understanding it, however knowledge about the disease has increased considerably over time, due to advances in genetics, immunology, imaging, and a better understanding of epidemiology. The exact prevalence is unknown, and its calculation is difficult due to the use of different diagnostic or classificatory criteria throughout the last decades. The present work aims to establish the prevalence of psoriatic arthritis in Colombia and to describe the basic demographic characteristics of patients with this disease from the official administrative clinical records of the Colombian Ministry of Health. ObjectiveTo estimate the prevalence and describe the main demographic characteristics of psoriatic arthritis in Colombia. Methodology and methodsCross-sectional study, based on official Ministry of Health registry data. Results6433 cases of psoriatic arthritis (ICD-10 code: M070, M071, M072, M073, L405) were reported between 2012 and 2018, for a prevalence in people over 18 years of 13.5 per 100,000 inhabitants, with a slight predominance of the female population (53%), with a female: male ratio of 1.12: 1, and a higher prevalence in the 55–59 year age group. Additionally, 149,130 cases of psoriasis were identified (ICD-10 code: L400, L401, L402, L403, L404, L408, L409), for a prevalence of psoriatic arthritis of 5.8% in psoriasis patients. ConclusionsThis is the first study to present demographic information on psoriatic arthritis in Colombia. Data from our study show a lower prevalence compared to other similar studies in the region.

Clinical practice guideline for the treatment of psoriatic arthritis in Colombia

IntroductionPsoriatic arthritis is a chronic inflammatory arthropathy characterized by subtypes with distinct phenotypes and variable clinical course, which requires optimal management of joint manifestations and skin involvement. ObjectivesThis study aims to provide recommendations for the pharmacological treatment of psoriatic arthritis based on evidence and applicability to the Colombian health system. Methodology and methodsThese guidelines were developed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Clinical experts, rheumatologists, and dermatologists formulated the recommendations based on clinical evidence, the disease's impact, patient values and preferences, and the resource availability in the country. ResultsThe guideline includes 12 recommendations related to the use of anti-inflammatory drugs, glucocorticoids, and disease-modifying antirheumatic drugs (DMARDs), including conventional synthetics, biologics, and targeted synthetic DMARD, for the PsA domains: peripheral disease, axial disease, enthesitis, and dactylitis. ConclusionsThis document presents a set of updated and evidence-based recommendations that guide decision-making about pharmacological management of psoriatic arthritis in adults in Colombia. They constitute general guidelines that should be interpreted and implemented according to the individualized evaluation of the patient and the medical criteria in the different clinical settings.

Clinical practice guideline for the treatment of psoriatic arthritis in Colombia

IntroductionPsoriatic arthritis is a chronic inflammatory arthropathy characterized by subtypes with distinct phenotypes and variable clinical course, which requires optimal management of joint manifestations and skin involvement. ObjectivesThis study aims to provide recommendations for the pharmacological treatment of psoriatic arthritis based on evidence and applicability to the Colombian health system. Methodology and methodsThese guidelines were developed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Clinical experts, rheumatologists, and dermatologists formulated the recommendations based on clinical evidence, the disease's impact, patient values and preferences, and the resource availability in the country. ResultsThe guideline includes 12 recommendations related to the use of anti-inflammatory drugs, glucocorticoids, and disease-modifying antirheumatic drugs (DMARDs), including conventional synthetics, biologics, and targeted synthetic DMARD, for the PsA domains: peripheral disease, axial disease, enthesitis, and dactylitis. ConclusionsThis document presents a set of updated and evidence-based recommendations that guide decision-making about pharmacological management of psoriatic arthritis in adults in Colombia. They constitute general guidelines that should be interpreted and implemented according to the individualized evaluation of the patient and the medical criteria in the different clinical settings.

Prevalence and demographic characteristics of psoriatic arthritis in Colombia: Data from the National Health Registry 2012–2018

IntroductionPsoriatic arthritis is an inflammatory arthritis with a wide range of manifestations. The complexity of the disease is a barrier to understanding it, however knowledge about the disease has increased considerably over time, due to advances in genetics, immunology, imaging, and a better understanding of epidemiology. The exact prevalence is unknown, and its calculation is difficult due to the use of different diagnostic or classificatory criteria throughout the last decades. The present work aims to establish the prevalence of psoriatic arthritis in Colombia and to describe the basic demographic characteristics of patients with this disease from the official administrative clinical records of the Colombian Ministry of Health. ObjectiveTo estimate the prevalence and describe the main demographic characteristics of psoriatic arthritis in Colombia. Methodology and methodsCross-sectional study, based on official Ministry of Health registry data. Results6433 cases of psoriatic arthritis (ICD-10 code: M070, M071, M072, M073, L405) were reported between 2012 and 2018, for a prevalence in people over 18 years of 13.5 per 100,000 inhabitants, with a slight predominance of the female population (53%), with a female: male ratio of 1.12: 1, and a higher prevalence in the 55–59 year age group. Additionally, 149,130 cases of psoriasis were identified (ICD-10 code: L400, L401, L402, L403, L404, L408, L409), for a prevalence of psoriatic arthritis of 5.8% in psoriasis patients. ConclusionsThis is the first study to present demographic information on psoriatic arthritis in Colombia. Data from our study show a lower prevalence compared to other similar studies in the region.

Culturally sensitive care of Misak Indigenous patients with rheumatoid arthritis in Colombia

To describe and understand the attitudes, cultural knowledge, and therapeutic practices of the Misak people concerning rheumatoid arthritis (RA), inscribed in an emergent culturally sensitive healthcare model along with the indigenous community and health professionals, following a respectful and empathic relational contact approach to the inter-ethnic encounter. A qualitative study that used ethnographic methods using observation techniques and in-depth interviews was carried out in the Misak community, Colombia, by a multidisciplinary team (rheumatology, physiotherapy, and anthropology). A thematic analysis based around the concept of explanatory models (EMs) was carried out. Researchers interviewed 20 patients with RA, 12 traditional healers, and 5 health professionals. The following themes were identified: (1) the traditional healers are allowed to practice only if the community recognizes their vocation; (2) two types of EM were observed: Misak community EM related to conception of RA and its treatment, shared by patients and the traditional healers; and biomedical EM. The interaction of the two types is still a healthcare challenge that requires articulating to achieve better clinical outcomes for patients. The EMs of RA care identified in the Misak community are focused on both the patients and the traditional healers. However, this predominant EM and the biomedical EM of RA care need to be brought closer together to contribute to the construction of a unifying model of a culturally sensitive care.

Management results of a cohort of rheumatoid arthritis patients in a specialized comprehensive healthcare institution in Colombia

ObjectiveTo determine the management results in a cohort of patients with rheumatoid arthritis in a specialized integral healthcare institution for this disease in Colombia. Materials and methodsDescriptive cross-sectional study based on a cohort of rheumatoid arthritis patients according to ACR/EULAR 2010 criteria. The information was analysed based on consolidated data from clinical records and national reports in the period 2015–2018. Administrative records related to medication authorizations and prescriptions were considered. Sociodemographic variables, outcome indicators related to disease activity status and medication use percentage were evaluated. ResultsAs of June 30th 2018, 698 patients were identified, of which the female sex represented 83.8%, the general average age was 55.47 years, and the highest number of cases were in the 60–64 year age group. Of the patients, 68.3% were between remission and low disease activity. Seventy-three point one percent were managed with conventional disease-modifying antirheumatic drugs and a reduction in the use of biological therapy was recorded from 27.2% in 2016 to 17.8% at the end of the period. ConclusionsThis study presents the management results of a comprehensive care model for patients with rheumatoid arthritis in Colombia, which managed to maintain the highest proportion of patients in low activity and remission as they had a longer follow-up time, to decrease the percentage of biological DMARDs use, and establish conventional DMARDs as the main therapeutic alternative.

Resultados de gestión en una cohorte de pacientes con artritis reumatoide en una institución de atención integral especializada en Colombia

ObjectiveTo determine the management results in a cohort of patients with rheumatoid arthritis in a specialized integral healthcare institution for this disease in Colombia. Materials and methodsDescriptive cross-sectional study based on a cohort of rheumatoid arthritis patients according to ACR/EULAR 2010 criteria. The information was analysed based on consolidated data from clinical records and national reports in the period 2015 to 2018. Administrative records related to medication authorizations and prescriptions were considered. Sociodemographic variables, outcome indicators related to disease activity status and medication use percentage were evaluated. ResultsAs of June 30th 2018, 698 patients were identified, of which the female sex represented 83.8%, the general average age was 55.47 years, and the highest number of cases were in the 60 to 64 year age group. Of the patients, 68.3% were between remission and low disease activity. Seventy-three point one percent were managed with conventional disease-modifying antirheumatic drugs and a reduction in the use of biological therapy was recorded from 27.2% in 2016 to 17.8% at the end of the period. ConclusionsThis study presents the management results of a comprehensive care model for patients with rheumatoid arthritis in Colombia, which managed to maintain the highest proportion of patients in low activity and remission as they had a longer follow-up time, to decrease the percentage of biological DMARDs use, and establish conventional DMARDs as the main therapeutic alternative.

Centers of Excellence Implementation for Treating Rheumatoid Arthritis in Colombia: A Cost-Analysis.

BackgroundHealth systems need to optimize the use of resources, especially in high-cost diseases as rheumatoid arthritis (RA). We aimed to evaluate the efficiency of using centers of excellence (CoE) as a strategy for improving RA treatment in Colombia.MethodsA cost description analysis was carried out using the standard costing technique. We estimated the costs of medical consultations, laboratories, images, and medications for RA. Categories of care standards stratified by severity were defined using the disease activity score in 28 joints (DAS28). We evaluated the impact, in terms of costs (US dollars), for providing RA clinical care for a previously described cohort using the CoE approach. Statistical analyses were performed in Microsoft Excel®, and R.ResultsExpenditure on therapeutic drugs increases as the severity of RA increases. Drugs represent 53.6% of the total cost for the low disease activity (LDA) stage, 75.2% for moderate disease activity (MDA), 88.5% for severe disease activity (SDA) and 97% for SDA with biologic treatment (SDA+Biologic). Treating 968 patients would cost US$612,639 (US$487,978–1,220,160) at baseline, per year. After a year of follow-up at the CoE, treating the same patients would cost US$388,765 (US$321,710–708,476), which implies potential cost-savings of up to US$223,874 per year.ConclusionThe strategy of providing clinical care for RA through CoE can save US$231.3 per patient-per year. The results of our study show that CoE could greatly impact the public policies dealing with treatment of RA in Colombia. Applying the CoE model in our country would both improve health outcomes, as well as being more efficient in terms of costs.

Rheumatoid arthritis in Colombia: a clinical profile and prevalence from a national registry

There is a need to describe the demographic and clinical characteristics of people diagnosed with rheumatoid arthritis who are attended within the Colombian health system. This characterization allows prioritizing populations with specific risks, programming the use of health services, and planning the costs necessary to guarantee equitable care. To assess the demographic and clinical characteristics of a cohort of patients with rheumatoid arthritis using national data collected by the High-Cost Disease Fund (CAC in Spanish). A cross-sectional study from a secondary source. Data was gathered from a national administrative registry. A descriptive analysis was performed on sociodemographic and clinical characteristics. Age-standardized prevalence was estimated at national level and by geographical regions. Remission rates were also estimated for Colombian departments and regions. By 2019, 81,386 patients with rheumatoid arthritis were reported in Colombia. The relation female-male was 5.2:1. The median age was 59 years (IQR: 50-67). Prevalence was higher in people aged 50-69 years. The most frequent comorbidities were high blood pressure (31.15%) and osteoporosis (19.46%). Age-standardized prevalence of rheumatoid arthritis was 0.24 per 100 population (95% CI: 0.23-0.24). In cases with complete information, 57.57% of departments had remission rates up to 30%. Rheumatoid arthritis in Colombia was more frequent in females aged ≥50 year. Age-standardized prevalence was lower than reported by other studies performed in Colombia but similar to the estimated internationally for the country. Key Points • More than 80,000 rheumatoid arthritis patients were reported to this national registry in Colombia in 2019, finding an age-standardized prevalence of 0.24 per 100 population. • Hypertension was the most common comorbidity reported in people with rheumatoid arthritis. This finding is similar to the reports by similar studies such as the COMORA. • A major strength of this study is the large sample size since data come from a nationwide registry of people with rheumatoid arthritis, supported by the National Ministry of Health. Additionally, this registry has a rigorous data monitoring process that guarantees the internal validity of data and provides valuable information for decision-making based on local evidence. • Prevalence of rheumatoid arthritis was higher in females between 50 and 65 years. Age-standardized prevalence was lower than previously reported in Colombia, but similar to the world estimations.

Prevalence of inflammatory bowel disease and related arthritis in Colombia, according to information from the Health and Social Protection Data System

IntroductionRegistries are essential to keep track of inflammatory bowel disease (IBD) and related arthritis epidemiology, and to provide better care to patients. In Colombia, the health ministry has adopted a tool, SISPRO, to gather all information coming from the whole health system structure. Given that the information collected from SISPRO is available for anyone, it provides an opportunity to get an insight into health topics. ObjectivesThe data collected from SISPRO were used to analyse the prevalence and specific characteristics of patients with IBD and related arthritis registered between 2012 and 2016. MethodsThis is a descriptive epidemiological study using the International Statistical Classification of Diseases and Related Health Problem as keywords related to IBD and related arthritis during the analysis of SISPRO data. ResultsNational records report 42,647 patients with a diagnosis of IBD for an estimated prevalence of 87/100,000 subjects, being more frequent in women. The prevalence of Crohn’s disease was 17/100,000 subjects, and 113/100,000 subjects for ulcerative colitis. The prevalence of arthritis related to inflammatory bowel disease was 5/100,000 subjects. ConclusionsThis is the first study that describes the demographic characteristics of IBD in Colombia. This study is in accordance with that previously described in the available literature, which supports the theory about increasing global prevalence of IBD. Also, there are some differences between Colombian regions, which could be related to environmental factors and ancestry, which deserve further study.

Prevalence of rheumatoid arthritis in Colombia based on information from the Ministry of Health registry

ObjectiveTo estimate the prevalence and describe the main demographic characteristics of rheumatoid arthritis in adults in Colombia. Material and methodsA descriptive cross-sectional study was conducted using the data taken from the Integral Information System of Social Protection of the Ministry of Health during the years 2012–2016. ResultsA total of 248,995 cases were identified, which gave an estimated prevalence of 0.52% in those older than 18 years of age. The large majority (80.7% were women, with a female:male ratio of 4.2:1, and there was a higher prevalence in the 70–74 years age group. The departments with the highest number of cases were Bogota DC (64,121), followed by Antioquia (43,771), but the departments with the highest prevalence were Cesar (1.13%), Casanare (0.96%), and Risaralda (0.93%). ConclusionsDemographic and epidemiological information on rheumatoid arthritis in Colombia is presented. A similar prevalence is reported in other studies from the region, like Brazil (0.46%), Venezuela (0.4%), or Peru (0.55%), but lower than Argentina (0.94%) or Mexico (1.6%).

Prevalencia de la artritis reumatoide en Colombia según información del Sistema Integral de Información de la Protección Social

ObjectiveTo estimate the prevalence and describe the main demographic characteristics of rheumatoid arthritis in adults in Colombia. Material and methodsA descriptive cross-sectional study was conducted using the data taken from the Integral Information System of Social Protection of the Ministry of Health during the years 2012 to 2016. ResultsA total of 248,995 cases were identified, which gave an estimated prevalence of 0.52% in those older than 18 years of age. The large majority (80.7% were women, with a female: male ratio of 4.2: 1, and there was a higher prevalence in the 70 to 74 years age group. The departments with the highest number of cases were Bogota DC (64,121), followed by Antioquia (43,771), but the departments with the highest prevalence were Cesar (1.13%), Casanare (0.96%), and Risaralda (0.93%). ConclusionsDemographic and epidemiological information on rheumatoid arthritis in Colombia is presented. A similar prevalence is reported in other studies from the region, like Brazil (0.46%), Venezuela (0.4%), or Peru (0.55%), but lower than Argentina (0.94%) or Mexico (1.6%).

Prevalence of rheumatic disease in Colombia according to the Colombian Rheumatology Association (COPCORD) strategy. Prevalence study of rheumatic disease in Colombian population older than 18 years

IntroductionRheumatic diseases are the leading cause of permanent disability. The COPCORD model is an effective tool in the determination of the prevalence of diseases. The objective of this study is to estimate the prevalence of rheumatic disease in a Colombian population over 18 years of age. MethodsA prevalence study was carried out using a probabilistic method of stratified random sampling in three stages: cartographic sectors in each city, selection of the blocks of each sector, and the households of each block. The COPCORD questionnaire adapted for Colombia was applied by standardized interviewers. Confirmation of the diagnosis was made by a rheumatologist with access to all the information. ResultsOut of a total of 6693 patients that completed the questionnaire, 64% were women. Pain not associated with trauma was reported by 48% of the participants. The most frequent locations were: knees 35%, hands 26%, lumbar spine 20%, and shoulders 16%. Non-specific skeletal muscle discomfort, osteoarthritis, regional appendicular syndrome, and non-inflammatory low back pain, were the most prevalent diseases. Rheumatoid arthritis and chronic inflammatory low back pain were the most common inflammatory conditions. The prevalence of Chikungunya fever was estimated at 6.68%. ConclusionThe prevalence of rheumatoid arthritis in Colombia is higher than commonly reported, lower than for fibromyalgia and gout, and similar for osteoarthritis, systemic lupus erythematosus and spondyloarthritis. In Colombia these diseases are a public health problem without awareness of their impact on the general population.

Prevalencia de la enfermedad reumática en Colombia, según estrategia COPCORD-Asociación Colombiana de Reumatología. Estudio de prevalencia de enfermedad reumática en población colombiana mayor de 18 años

IntroductionRheumatic diseases are the leading cause of permanent disability. The COPCORD model is an effective tool in the determination of the prevalence of diseases. The objective of this study is to estimate the prevalence of rheumatic disease in a Colombian population over 18 years of age. MethodsA prevalence study was carried out using a probabilistic method of stratified random sampling in three stages: cartographic sectors in each city, selection of the blocks of each sector, and the households of each block. The COPCORD questionnaire adapted for Colombia was applied by standardised interviewers. Confirmation of the diagnosis was made by a rheumatologist with access to all the information. ResultsOut of a total of 6,693 patients that completed the questionnaire, 64% were women. Pain not associated with trauma was reported by 48% of the participants. The most frequent locations were: knees 35%, hands 26%, lumbar spine 20%, and shoulders 16%. Non-specific skeletal muscle discomfort, osteoarthritis, regional appendicular syndrome, and non-inflammatory low back pain, were the most prevalent diseases. Rheumatoid arthritis and chronic inflammatory low back pain were the most common inflammatory conditions. The prevalence of Chikungunya fever was estimated at 6.68%. ConclusionThe prevalence of rheumatoid arthritis in Colombia is higher than commonly reported, lower than for fibromyalgia and gout, and similar for osteoarthritis, systemic lupus erythematosus and spondyloarthritis. In Colombia these diseases are a public health problem without awareness of their impact on the general population.

Time to and factors associated with initiation of biological therapy in patients with rheumatoid arthritis in Colombia

AimsTo determine the time Colombian patients with rheumatoid arthritis (RA) are treated with non-biological disease-modifying antirheumatic drugs (DMARDs) before changing to biological therapy. MethodsA retrospective cohort study that collected information about the start of antirheumatic treatment in patients of all ages with a diagnosis of RA until the change to biological DMARD therapy. Survival analysis using Kaplan–Meier curves, from 1 January 2007 until 31 December 2013 by SPSS 23.0 for Windows, was made. ResultsA total of 3880 patients (75.3% women) with a mean age of 51.3 years started non-biological DMARDs. After 5 years, 234 patients (6.0%) initiated biological DMARD therapy in 17.5±13.9 months. The use of glucocorticoids (OR: 2.49; 95% CI: 1.658–3.732), having any comedication (OR: 1.83; 95%CI: 1.135–2.966) and being treated in the city of Bogota (OR: 2.30; 95%CI: 1.585–3.355) or in the cities of the Colombian Atlantic coast (OR: 2.848; 95%CI: 1.468–5.524) were associated with a higher likelihood of biological DMARD initiation. Whereas the initiation of therapy with methotrexate (OR: 0.04; 95% CI: 0.014–0.108; p<0.001) or chloroquine (OR: 0.13; 95% CI: 0.092–0.187; p<0.001) or receiving antihypertensive medication (OR: 0.64; 95% CI: 0.421–0.960; p=0.031) was associated with a significant reduce in likelihood. ConclusionAfter 5 years of non-biological DMARD therapy, 6.0% of people with RA started biological DMARDs. Receiving glucocorticoids, having any comedication, being treated in Bogota City or cities of the Colombian Atlantic coast affected the probability of switching to biological therapy in these patients.

Time to and factors associated with initiation of biological therapy in patients with rheumatoid arthritis in Colombia

AimsTo determine the time Colombian patients with rheumatoid arthritis (RA) are treated with non-biological disease-modifying antirheumatic drugs (DMARDs) before changing to biological therapy. MethodsA retrospective cohort study that collected information about the start of antirheumatic treatment in patients of all ages with a diagnosis of RA until the change to biological DMARD therapy. Survival analysis using Kaplan–Meier curves, from 1 January 2007 until 31 December 2013 by SPSS 23.0 for Windows, was made. ResultsA total of 3880 patients (75.3% women) with a mean age of 51.3 years started non-biological DMARDs. After 5 years, 234 patients (6.0%) initiated biological DMARD therapy in 17.5±13.9 months. The use of glucocorticoids (OR: 2.49; 95% CI: 1.658–3.732), having any comedication (OR: 1.83; 95%CI: 1.135–2.966) and being treated in the city of Bogota (OR: 2.30; 95%CI: 1.585–3.355) or in the cities of the Colombian Atlantic coast (OR: 2.848; 95%CI: 1.468–5.524) were associated with a higher likelihood of biological DMARD initiation. Whereas the initiation of therapy with methotrexate (OR: 0.04; 95% CI: 0.014–0.108; p<0.001) or chloroquine (OR: 0.13; 95% CI: 0.092–0.187; p<0.001) or receiving antihypertensive medication (OR: 0.64; 95% CI: 0.421–0.960; p=0.031) was associated with a significant reduce in likelihood. ConclusionAfter 5 years of non-biological DMARD therapy, 6.0% of people with RA started biological DMARDs. Receiving glucocorticoids, having any comedication, being treated in Bogota City or cities of the Colombian Atlantic coast affected the probability of switching to biological therapy in these patients.

Rheumatoid arthritis prevalence in Colombia: An approach based on burden of disease study during 2005

Abstract Introduction The prevalence of rheumatoid arthritis (RA) in Colombia is currently unknown. The purpose of this study was to estimate the prevalence of rheumatoid arthritis in Colombia using document bases. Material and methods A search was made of administrative sources for prevalent cases of RA reported by the Colombia 2005 Disease Burden study and the Servicing Individual Health Records, and corresponding to the International Classification of Diseases, tenth edition codes M05 and M06. The specific prevalences by sex and age were estimated by dividing the prevalent cases identified by the population bases reported by the National Bureau of Statistics in Colombia for the same year. Results A total of 267,628 prevalent cases were found in Colombia in 2005. The overall prevalence of rheumatoid arthritis was 0.9/100 inhabitants, with a rheumatoid arthritis female/male ratio of 4:1. A progressive increase with age was observed (peaking in the group older than 80 years). Conclusion This is the first study of the prevalence of rheumatoid arthritis in Colombia based on administrative records. The prevalence for this methodology was similar to that found by other studies in populations of Europe and South America.

Prevalencia de artritis reumatoide en Colombia: una aproximación basada en la carga de la enfermedad durante el año 2005

IntroductionThe prevalence of rheumatoid arthritis (RA) in Colmbia is currently unknown. The purpose of this study was to estimate the prevalence of rheumatoid arthritis in Colombia using document bases. Material and methodsA search was made of administrative sources for prevalent cases of RA reported by the Colombia 2005 Disease Burden study and the Servicing Individual Health Records, and corresponding to the International Classification of Diseases, tenth edition codes M05 and M06. The specific prevalences by sex and age were estimated by dividing the prevalent cases identified by the population bases reported by the National Bureau of Statistics in Colombia for the same year. ResultsA total of 267,628 prevalent cases were found in Colombia in 2005. The overall prevalence of rheumatoid arthritis was 0.9/100 inhabitants, with a rheumatoid arthritis female/male ratio of 4:1. A progressive increase with age was observed (peaking in the group older than 80 years). ConclusionThis is the first study of the prevalence of rheumatoid arthritis in Colombia based on administrative records. The prevalence for this methodology was similar to that found by other studies in populations of Europe and South America.

Descripción del estado de salud y calidad de vida en pacientes tratados con etanercept dentro de un programa de atención para artritis reumatoide en un centro especializado en Colombia

ObjectiveWe conducted a descriptive analysis of rheumatoid arthritis activity according to DAS28, and functionality with HAQ (Health Assessment Questionnaire), and depression scales after one year of follow-up, in a disease management program «Evaluación día» for Colombian patients whom started treatment with etanercept. MethodsWe designed a program as part of an integral disease management. It involved four visits, including: lab tests, questionnaires, and clinical evaluation by rheumatologist, psychologist, physical and occupational therapist. Results91 patients were included. At the beginning of the program, 80.7% of the individuals were classified in moderate and severe disease activity. At the end of follow-up, disease remission by DAS28 was reached in 25% of the patients. The number of patients who experienced DAS28 reduction more than 1.2 points was 19 (37.5%). HAQ average at baseline was 1.07 and improved to 0.96 at the end of the follow-up. At baseline, 33.3% of patients had a mayor depression according to Zung Score and, after one year, this score was present in 21.9% of the patients. ConclusionsThe description of this disease management program is important for the understanding of rheumatoid arthritis in Colombia and it may offer an integral treatment, which is necessary in all chronic diseases. The results found in this analysis seem to be similar as described in other observations.

Cost-effectiveness of biological therapy compared with methotrexate in the treatment for rheumatoid arthritis in Colombia

The objectives of the study are to develop a cost-effectiveness model comparing biological therapy (BT) with methotrexate (MTX) alone, in the treatment for rheumatoid arthritis (RA), combining clinical and quality-of-life data from international trials with local costs and local epidemiological data. We designed a six-month cycle Markov model with five functional states, based on Health Assessment Questionnaire, with patients initiating treatment in any of the predefined states, based on a sample of 150 local RA patients. Simulations ran for 10 and 20 years, and for the whole life span. Utilities, in quality-adjusted life years (QALY), were taken from international literature. Discount rate was 3 % for costs and utilities. We calculated direct and indirect costs using a combination of international and local data. Results are presented as incremental cost-effectiveness ratios (ICER). ICERs in euros per QALY were <euro>143,072 for 10 years; <euro>139,332 for 20 years; and <euro>137,712 for the whole life span. Total costs with MTX were lower than with BT, despite higher out of pocket, productivity, and complication costs. Under conventional thresholds, and for the "average" RA patient, BT would not be cost-effective in Colombia. BT compared to MTX provides more QALYs, but at a high cost. When ICERs were estimated for Colombia, BT would not be cost-effective. We propose different thresholds for different conditions, perhaps prioritizing chronic diseases that lead to disability.