En Reumatología, ¿generamos los maestros que el siglo XXI necesita? / In Rheumatology, do we generate the teachers that the 21st century needs?

¿Quiénes deberían ser maestros de la Reumatología Argentina? Uno pensaría los mejores. ¿Son los mejores? ¿Cuál debería ser el criterio de selección para tan honroso y destacado sitio? Nuestra Sociedad exige: "Todos aquellos que hayan cumplido 65 años y que con su actividad académica mediante, formaron jóvenes reumatólogos". ¿Cómo los formaron? ¿Sabemos? ¿Técnicos o humanistas? La formación de un discípulo, en este caso en Reumatología, debe ser integral. No solo lo técnico, sino también de igual importancia en lo humano. Un maestro dialoga, mantiene un ideal, renuncia al enriquecimiento y muestras sus llagas.

Who should be the great educators and masters of Argentinian Rheumatology? One would think they should be the best ones! But are they the best ones? What ought to be the selection criteria for such a distinguished and honourable position? Our society demands: "All of those who have turned 65 years old and who, thanks to their academic work, have trained young rheumatologists". How the latter were trained? Do we know? As mere technicians or as humane professionals? The academic training of a pupil of Rheumatology, as in this case, must be comprehensive. Not only the technical but also the human aspect is of the utmost importance. An educator converses, is true to an ideal, gives up/sacrifices enrichment and reveals their weak points.

Virtual learning environment in pediatric rheumatology for pediatric residents / Ambiente virtual de aprendizagem em reumatologia pediátrica para residentes em pediatria

ABSTRACT Objective: To develop, implement and evaluate an online virtual learning environment (VLE) on pediatric rheumatology, aimed at pediatric residents, analyzing its effectiveness and satisfaction rates. Methods: A total of 92 first and second year pediatric residents at two pediatric reference centers were invited to participate in the study. Residents were randomized into a case group (that answered the pre-course test, attended the six virtual pediatric rheumatology modules, and then responded to the post-course test and a satisfaction questionnaire) and a control group (that only answered the pre-course test and, after 4 weeks, the post-course test). Results: Forty-seven residents (51%) completed their participation. In the case group (n=24), the mean percentage of correct answers was 14% higher on the post-course test (p<0.001). The number of correct answers was larger in the case group than in the control one (n=23) in the post-course test (p=0.045). In the assessment of satisfaction with VLE use, residents considered the site easy to navigate (91%), suitable as a learning tool (91%), and attractive in design (79%). They reported poor prior knowledge in pediatric rheumatology (91%) and agreed that there was good learning with the methodology (75%). Conclusions: The virtual learning environment in pediatric rheumatology proved to be an effective teaching tool with high satisfaction rates, providing pediatrician residents with adequate knowledge regarding the initial assessment and management of children with rheumatic diseases.

RESUMO Objetivo: Elaborar, implementar e avaliar um ambiente virtual de aprendizagem online em reumatologia pediátrica, direcionado aos residentes em pediatria, analisando sua efetividade e seus índices de satisfação. Métodos: Foram convidados 92 residentes de pediatria do primeiro e segundo anos de dois centros de referência em pediatria. Os residentes foram divididos, de forma randomizada, em grupo caso (que respondeu ao teste pré-curso, assistiu aos seis módulos virtuais de reumatologia pediátrica e, ao término das aulas virtuais, respondeu ao teste pós-curso e ao questionário de satisfação) e grupo controle (que apenas respondeu ao teste pré-curso e, após quatro semanas, ao teste pós-curso). Resultados: Completaram a participação 47 (51%) residentes. No grupo caso (n=24), o percentual de acertos foi 14% maior no teste pós-curso (p<0,001). Houve um percentual de acertos maior no grupo caso em relação ao grupo controle (n=23) na comparação do resultado do teste pós-curso (p=0,045). Na avaliação da satisfação em relação ao uso do ambiente virtual, os residentes consideraram o site de fácil navegação (91%), adequado como ferramenta de aprendizagem (91%) e com design atrativo (79%). Eles relataram um conhecimento prévio ruim em reumatologia pediátrica (91%) e concordaram que houve um bom aprendizado por meio da metodologia (75%). Conclusões: O ambiente virtual de aprendizado em reumatologia pediátrica mostrou-se uma ferramenta de ensino eficaz e com altos índices de satisfação na sua utilização, fornecendo ao residente em pediatria um conhecimento adequado para avaliação e conduta inicial de pacientes com doenças reumáticas da infância.

Más allá del diagnóstico: comunicación, lenguaje y empatía / Beyond diagnosis: communication, language and empathy

La medicina actual, inmersa en una sociedad fría e individualista, se ha alejado de la buena comunicación con el enfermo. Es fundamental que en la formación médica más allá de entender la enfermedad, se comprenda al ser humano que la padece, lo que es parte del humanismo médico. La buena comunicación, más aún si es de una mala noticia para el enfermo y su entorno cercano, debe acompañarse de un lenguaje adecuado y un grado de empatía, que trasmitan una esperanza que no se aparte de la veracidad y la realidad.

Medicine today, immersed in a cold and individualistic society, has moved away from good communication with the patient. It is essential in medical training more beyond to understand disease, comprise the human suffering it, which is part of medical humanism. Good communication, even if it is bad news for the sick and their close environment, must accompanied by a suitable language and a degree of empathy, that convey hope to not depart from the truth and reality, accompanied by a suitable language and a degree of empathy, that convey hope to not depart from the truth and reality.

Development of rheumatology training in Brazil: the option for a medical residency program / Evolução da formação de reumatologistas no Brasil: a opção pela residência médica

Abstract Objective To describe the characteristics and progression of the supply of new rheumatologists in Brazil, from 2000 to 2015. Methods: Consultations to databases and official documents of institutions related to training and certification of rheumatologists in Brazil took place. The data were compared, summarized and presented descriptively. Results: From 2000 to 2015, Brazil qualified 1091 physicians as rheumatologists, of which 76.9% (n = 839) completed a medical residency program in rheumatology (MRPR); the others (n = 252) achieved this title without MRPR training. There was an expansion of MRPR positions. At the same time, there was a change in the profile of the newly qualified doctors. Early in the series, the fraction of new rheumatologists without MRPR, entering the market annually, was approaching 50%, dropping to about 15% in recent years. In 2015, Brazil offered 49 MRPR accredited programs, with 120 positions per year for access. There was an imbalance in the distribution of MRPR positions across the country, with a strong concentration in the southeast region, which in 2015 held 59.2% of the positions. Public institutions accounted for 94% (n = 789) of graduates in MRPR during the study period, while still maintaining 93.3% (n = 112) of seats for admission in 2015. Conclusions: In the last sixteen years, in parallel with the expansion of places of access, MRPR has established itself as the preferred route for rheumatology training in Brazil, mainly supported by public funds. Regional inequalities in the provision of MRPR positions still persist, as challenges that must be faced.

Resumo Objetivo: Descrever as características e a evolução da oferta de novos reumatologistas no Brasil, de 2000 a 2015. Métodos: Fizeram-se consultas a bases de dados e a documentos oficiais de instituições relacionadas à formação e à certificação de reumatologistas no país. Os dados foram cruzados, sumarizados e apresentados de forma descritiva. Resultados: De 2000 até 2015, o Brasil habilitou 1.091 médicos à condição de reumatologistas, dentre os quais 76,9% (n = 839) concluíram residência médica em reumatologia (RMR); os demais (n = 252) obtiveram o título sem cursar RMR. Houve expansão das vagas de RMR. Paralelamente, ocorreu uma modificação no perfil dos recém-habilitados. No início da série, a fração de novos reumatologistas sem RMR, ingressantes no mercado anualmente, aproximava-se dos 50%, reduziu-se para cerca de 15%, em anos recentes. Em 2015, havia no país 49 programas de RMR credenciados, com 120 vagas anuais de acesso. Observou-se desequilíbrio na distribuição de vagas de RMR pelo país, com forte concentração na Região Sudeste, que em 2015 detinha 59,2% das vagas. Instituições públicas responderam por 94% (n = 789) dos concluintes de RMR no período estudado, mantiveram ainda 93,3% (n = 112) das vagas para ingresso em 2015. Conclusões: Nos últimos 16 anos, paralelamente à expansão das vagas de acesso, a RMR consolidou-se como via preferencial para formação em reumatologia no Brasil, eminentemente suportada por recursos públicos. Desigualdades regionais na oferta de vagas de RMR persistem como desafios a serem enfrentados.

Interventional rheumatology: the competence of Brazilian rheumatologists / Reumatologia intervencionista: competência dos reumatologistas brasileiros

Abstract Objectives: Describe Brazilian rheumatologists's competence in interventional rheumatology; assess the association between this ability and demographic and training variables. Methods: A cross-sectional study with 500 Brazilian rheumatologists. Participants were assessed by self-administered questionnaire consisting of demographics, training, practice in office and knowledge in interventional rheumatology data. Results: 463 participants had their data analyzed. The mean age was 40.2 years (±11.2). 70% had performed periarticular injections and 78% had performed intra-articular injections. The sample was divided into three groups: non-interventionist, little interventionist and very interventionist. The non-interventionist group showed (p < 0.001-0.04) higher mean age, lower proportion of university bond, lower training history, higher proportion of graduates in the Southeast country, and higher proportion of graduates in the 1980s to 1989. The very interventionist group showed higher (p < 0.001-0.018) proportion of adult rheumatologists, higher proportion of university bond, longer training time with greater practice of complex procedures, and higher proportion of graduates, trained and with private practice in the South country. Variables most associated with the very interventionist subgroup are performing axial intra-articular injections (OR: 7.4, p < 0.001), synovial biopsy (OR: 5.75, p = 0.043), image-guided IAI (OR: 4.16, p < 0.001), viscosupplementation (OR = 3.41, p < 0.001), joint lavage (OR = 3.22, p = 0.019), salivary gland biopsy (OR = 2.16, p = 0.034) and over 6-month training (OR: 2.16, p = 0.008). Conclusions: Performing more complex invasive procedures and over 6-month training in interventional rheumatology were variables associated with enhanced interventional profile.

Resumo Objetivos: Descrever a competência dos reumatologistas brasileiros na reumatologia intervencionista (RI); avaliar a associação entre essa capacidade e variáveis demográficas e de treinamento. Métodos: Fez-se um estudo transversal com 500 reumatologistas brasileiros. Os participantes foram avaliados por questionário autoadministrado, constituído por dados demográficos, treinamento, prática em consultório e conhecimento em dados de RI. Resultados: Analisaram-se os dados de 463 participantes. A média foi de 40,2 anos (± 11,2). Desses, 70% fizeram injeções periarticulares (IPA) e 78% intra-articulares (IIA). A amostra foi dividida em três grupos: não intervencionista, pouco intervencionista e muito intervencionista. O grupo não intervencionista apresentou (p < 0,001 - 0,04) maior média de idade, menor proporção de vínculo universitário, menor história de treinamento, maior proporção de graduados na Região Sudeste do país e maior proporção de graduados nas décadas de 1980 a 1989. O grupo muito intervencionista apresentou (p < 0,001 - 0,018) maior proporção de reumatologias que atendem pacientes adultos, maior proporção de vínculo universitário, maior tempo de treinamento de prática de procedimentos complexos, maior proporção de graduados no sul do país, treinados e com consultório particular nessa região. As variáveis mais frequentemente associadas ao subgrupo muito intervencionista foram realização de IIA axial (OR: 7,4, p < 0,001), biópsia sinovial (OR: 5,75, p = 0,043), IIA guiada por imagem (OR: 4,16, p < 0,001), viscossuplementação (OR = 3,41, p < 0,001), lavagem articular (OR = 3,22, p = 0,019), biópsia da glândula salivar (OR = 2,16, p = 0,034) e mais de seis meses de treinamento (OR: 2,16; p = 0,008). Conclusões: Fazer procedimentos invasivos mais complexos e ter mais de seis meses de treinamento em RI foram as variáveis associadas a um maior perfil intervencionista.

Rheumatology in India: a Bird's Eye View on Organization, Epidemiology, Training Programs and Publications

India is home to the world's second largest population. Rheumatology is an emerging specialty in India. We reviewed organization, epidemiology and training facilities for Rheumatology in India. Also, we also looked at publications in the field of rheumatology from India from over the past six years using Scopus and Medline databases. Despite rheumatologic disorders affecting 6%-24% of the population, rheumatology in India is still in its infancy. Till recently, there were as few as two centers in the country training less than five fellows per year. However, acute shortage of specialists and increasing patient numbers led to heightened awareness regarding the need to train rheumatologists. Subsequently, six new centers have now started 3-year training programs in rheumatology. The epidemiology of rheumatic diseases in India is being actively studies under the Community Oriented Programme for Control of Rheumatic Diseases (COPCORD) initiative. The most number of publications on rheumatic diseases from India are on rheumatoid arthritis, lupus and osteoporosis, many of which have been widely cited. Major collaborators worldwide are USA, UK and France, whereas those from Asia are Japan, Saudi Arabia and Singapore. The Indian Rheumatology Association (IRA) is the national organization of rheumatologists. The flagship publication of the IRA, the Indian Journal of Rheumatology, is indexed in Scopus and Embase. To conclude, rheumatology in India is an actively expanding and productive field with significant contributions to world literature. There is a need to train more personnel in the subject in India.

Inequalidade na distribuição de reumatologistas no Brasil: correlação com local de residência médica, Produto Interno Bruto e Índice de Desenvolvimento Humano / Inequality in the distribution of rheumatologists in Brazil: correlation with local of medical residency, Gross Domestic Product and Human Development Index

Objetivo: Avaliar a distribuição dos reumatologistas no Brasil e sua correlação com oferta de residência médica (RM) especializada, Produto Interno Bruto (PIB) e Índice De Desenvolvimento Humano Municipal (IDH-M) das unidades da federação (UFs). Métodos: Consulta a várias bases de dados oficiais, sumarização de dados por técnicas estatísticas descritivas e cruzamento de informações. Para análise de correlação, utilizou-se o coeficiente de Spearman (r). Resultados: Foram encontrados 1.229 reumatologistas registrados regularmente no país. A região Norte reunia apenas 3,6% desse contingente (n = 44), enquanto o Sudeste, 42,2% (n = 519). As capitais somadas aos cinco maiores municípios de cada UF concentraram 75,8% desses especialistas (n = 931). No total, 49,9% dos reumatologistas prestavam atendimento pelo Sistema Único de Saúde (SUS). Achou-se razão geral de 157.809 habitantes para cada reumatologista no Brasil, porém com grande variação entre as UF quanto a essa proporção. Entre 2000 e 2012, houve 593 concluintes de RM em reumatologia no Brasil. Achou-se correlação positiva do número de reumatologistas ante o PIB (r = 0,94), o IDH-M da capital (r = 0,77) e o número de concluintes de RM em reumatologia (r = 0,79) das UF. Conclusões: Observou-se forte concentração de reumatologistas nas capitais e maiores municípios brasileiros, com inequalidades perceptíveis também entre as UF e as regiões do país. A distribuição desses profissionais acompanhou o PIB, o IDH-M da capital e o número de concluintes de RM em reumatologia das UF, sugerindo que fatores relacionados a oportunidades de renda e desenvolvimento humano e ao local de formação especializada podem influir na fixação geográfica ...

Objective: To assess the distribution of rheumatologists in Brazil and their correlation with Medical Residency specialization offer, Gross Domestic Product (Gdp) And Municipal Human Development Index (HDI-M) of units of the federation (UFs). Methods: Query to various official databases, data summarization by techniques for descriptive statistics and cross-referenced information. For correlation analysis, we used the Spearman correlation coefficient (r). Results: There were 1229 rheumatologists regularly registered in the country. The Northern region had only 3.6% of the total (n = 44), while the Southeast had 42.2% (n = 519). The State capitals, added to the five largest municipalities in each UF, concentrated 75.8% of these specialists (n = 931). In total, 49.9% of rheumatologists offered treatment at SUS. A general ratio of 157,809 inhabitants per rheumatologist in Brazil was determined, but with wide variation among UFs with respect to this ratio. In the years 2000-2012, there were 593 Rheumatology Residency graduated physicians in Brazil. We observed a positive correlation among number of rheumatologists compared with GDP (r = 0.94), HDI-M of the State capitals (r = 0.77) and number of Rheumatology Residency graduated physicians (r = 0.79) in UFs. Conclusions: We noted a strong concentration of rheumatologists in State capitals and larger municipalities, with noticeable inequalities also between UFs and country regions. The distribution of these professionals accompanied GDP, HDI-M of the State capital and number of Rheumatology Residency graduated physicians, suggesting that factors related to income opportunities and human development and the place of speciality training may influence the geographical fixation of rheumatologists.

Perfil dos pacientes adultos atendidos em ambulatório de reumatologia em um hospital geral em Porto Alegre – RS / Characteristics of adult persons consulting in an outpatient rheumatology office in a general hospital in Porto Alegre – RS

Introdução: O conhecimento do perfil dos pacientes atendidos em um serviço médico é de fundamental importância para o planejamento de ações preventivas e curativas. As doenças reumáticas são reconhecidas pela cronicidade das queixas e grande morbidade que as acompanham, acarretando grande prejuízo em qualidade de vida e custo elevado para os sistemas de saúde. Objetivo: Verificar o perfil dos pacientes adultos atendidos no ambulatório de reumatologia do Complexo Hospitalar Santa Casa de Porto Alegre, RS. Métodos: Estudo ransversal descritivo, realizado através da aplicação de questionário na primeira consulta de pacientes atendidos no ambulatório de Reumatologia da Santa Casa, em período de seis meses. Resultados: Foram entrevistados 276 pacientes com média de idade de 52,5 anos, sendo 77,5% do sexo feminino e 56% procedentes de Porto Alegre. O tempo de ocorrência das queixas era de mais de um ano em 34,8% dos questionados, sendo que 12,7% tinham doença por tempo maior do que cinco anos. Trinta e quatro por cento dos pacientes já haviam buscado reumatologista previamente, sendo que 37,5% destes já haviam consultado cinco ou mais vezes pela mesma queixa. Médicos de outras especialidades foram procurados por 66%, sendo os traumatologistas os mais prevalentes (52%). Conclusão: Doenças articulares representam a segunda principal causa de incapacidade para o trabalho e o custo anual no atendimento desses pacientes repercute fortemente sobre os serviços de saúde. O investimento em políticas de saúde pública, com ações preventivas e curativas parte do conhecimento do perfil dos pacientes atendidos em determinado serviço de saúde.

Introduction: Knowledge of the profile of patients cared for at a medical service is critical for planning preventive and therapeutic strategies. Rheumatic diseases are known for the chronicity of complaints and associated high morbidity, leading to decreased quality of life for the patients and elevated costs for the health systems. Aim: To determine the profile of adults patients cared for at a rheumatology service of the Hospital Complex Santa Casa of Porto Alegre, RS. Methods: This is a descriptive cross-sectional study carried out through the application of a questionnaire responded by outpatients at their first visit to the above-mentioned rheumatology service during 6 months. Results: 276 patients (mean age = 52.5 years) were interviewed, of whom 77.5% were females and 56% lived in Porto Alegre. The reported beginning of complaints were older than one year among 34.8% of the sample, and 12.7% had the disease for longer than 5 years. 34% of the respondents had consulted with a rheumatologist in the past, and among these, 37.5% had already consulted five or more times because of the same complaint. Physicians of specialties other than rheumatology were consulted by 66% of the patients, traumatologists being the most prevalent ones (52%). Conclusion: Joint disorders are the second leading cause of disability for work, and the annual cost for caring for these patients exacts a heavy toll from health systems. The investment in public health policies, with preventive and therapeutic strategies, should start from knowledge of the profile of patients cared for at a particular health service.

El rol actual de la ultrasonografía en reumatología / Actual role of ultrasonography in rheumatology

A lo largo de los últimos años diversos estudios han demostrado la utilidad de la ultrasonografía (US) del aparato musculoesquelético en la práctica reumatológica cotidiana. Sus ventajas, tales como la inocuidad, la ausencia de radiaciones, el bajo costo y la reproducibilidad, la posicionan como una técnica de imágenes que brinda una potencial ayuda en la orientación diagnóstica y en el manejo de las enfermedades o síndromes de interés reumatológico. Las principales indicaciones de la US en Reumatología incluyen: el estudio de los síndromes regionales dolorosos, la identificación de los cambios morfoestructurales que se verifican en la artritis temprana y crónica, el monitoreo a corto plazo de la terapia y su utilidad como guía para los procedimientos invasivos. El periodo de aprendizaje relativamente largo y la carencia de criterios estandarizados para la ejecución e interpretación de la imagen son los principales obstáculos para el empleo difuso de este método. Debe también recordarse que un adecuado y profundo conocimiento anatomoclínico de las enfermedades reumatológicas y de la semiología ultrasonográfica son requisitos fundamentales para una rápida y eficaz formación en el campo de la US musculoesquelética.

Over the last years, several studies have highlighted the value of ultrasonography (US) for both clinical and research purposes in rheumatology. Ultrasonography is a non-invasive, inexpensive and free-of-radiation-hazards imaging technique providing quick and useful information for the diagnosis and management of rheumatic diseases. The main indications of ultrasonography in rheumatology include the evaluation of patients with regional pain syndromes and chronic arthritis, short-term therapy monitoring and guidance for invasive procedures. Ultrasonography’s long learning curve is the main obstacle that hinders its widespread use in rheumatology. Many technical aspects may affect the scanning process, and a correct interpretation of sonographic images depends on several elements such as a deep knowledge of ultrasonography anatomy and pathology.

Autoevaluación de fortalezas, debilidades y confianza de los médicos de atención primaria en el abordaje de enfermedades reumatológicas / Self assessment of strengths, weaknesses and self confidence¿ of primary care physicians taking care of rheumatic diseases

Background: Rheumatologic diseases are common and frequently managed by primary care physicians. Aim: To assess strengths, weaknesses and self confidence of primary care physicians in the management of rheumatic diseases. Material and methods: A self assessment and anonymous questionnaire was mailed to primary care physicians of two Chilean regions. Using a 10 points Likert scale, they were asked about personal interest, undergraduate training, continuous medical education, availability of medical literature, complementary laboratory tests and consultation with a rheumatologist. Medical skills, knowledge, therapeutic approach and performance of rheumatologic procedures were evaluated under the item confidence. Results: Three hundred forty seven out of 763 physicians (45%) answered the questionnaire. Their age range extended from 25 to 75 years, 59% were male, 58% were Chilean and 74% worked in the Metropolitan region. The worst evaluated parameters were availability of literature with a score of 2.2±2, access to consultation with a rheumatologist (3.8±2.2) and to continuous medical education (4.3±2.7). Physicians had a better confidence in their knowledge (6.7±1.5) and in their therapeutic approach (6.1±1.5). The worst confidence score was for shoulder injection therapy (3.4±2.6). Continuous medical education correlated with knowledge but not with clinical skills. Conclusions: Primary care physicians perform a bad assessment of their skills in rheumatology. They have a low level of confidence in their clinical skills to perform rheumatologic procedures. Continuous medical education improves confidence in knowledge but not in skills.

Efecto de un manual educativo sobre conocimientos y actitudes en pacientes reumáticos y personal de salud / Impact of an educational handbook on knowledge and attitudes of rheumatic patients and health workers

To assess the impact of the educational manual Aches and Pain, on knowledge and attitudes of patients with chronic rheumatism and paramedics, using an instrument with 40 aseverations extracted from the manual, 77 patients and 42 paramedics were studied. The assessment instrument was responded before and after reading chapters of the manual, selected by the authors. Knowledge was quantified according to the number of correct answers. Adaptation to disease, optimism and self help capacity were the evalauted attitudes, using a five point scale. The study was completed by 48 patients and 42 paramedics. Knowledge improved from 19,9ñ5,3 to 25,6ñ6,15 correct answers in the former and from 23,6ñ4,9 to 30,3ñ5,5 in the latter (p<0,001), In patients there were improvements in the degree of adaptation to disease from 3,3ñ0,9 to 4,0ñ0,8 and in selfhelp capacity from 4,0ñ0,8 to 4,3ñ0,8; optimism did not improve significantly. In conclusion, the eductinal manual had an impact on knowledge and improved rheumatic patient's attitudes towards the disease

Frecuencia del empleo de recursos no comprobados en el manejo de enfermedades reumáticas / Frequency of use of unproven remedies in rheumatic diseases

Objetivo. Determinar la frecuencia del empleo de recursos no comprobados (RNC) en pacientes con enfermedades reumáticas (ER). Pacientes y métodos. Estudiamos de manera prospectiva 80 pacientes que acudieron por primera vez a consulta de Reumatología y a todos se les aplicó de manera directa un cuestionario a propósito de 35 RNC tomados de la experiencia cotidiana de médicos, pacientes y público en general. Resultados. 58/80 pacientes fueron mujeres; las edades del grupo estudiado variaron de 13 a 83 años con promedio de 48.2 años; el tiempo de evolución varió de 1 mes a 20 años con promedio de 4.7 años; 13 pacientes fueron analfabetas y en los 67 restantes el promedio de escolaridad fue de 6.5 años. De los pacientes, 59/80 (73.75 por ciento) utilizaron RNC en algún momento de la evolución de su padecimiento; el número de RNC varió de 1 a 12 con promedio de 2.52 RNC por paciente, considerando el grupo total de 80 enfermos. Cuarenta pacientes utilizaron de 1.3 RNC, 14 usaron 10 o más RNC; 3 usaron de 7-9 RNC y 2 usaron 10 o más RNC. El análisis de diversas variables demográficas entre sí resultó compleja, encontrándose únicamente una correlación estadísticamente significativa entre mayor tiempo de evolución y mayor empleo de RNC (X2 = 58.42 con p < 0.001). Conclusiones. el empleo de RNC es muy frecuente en nuestro medio. Es necesario informar a los pacientes y la población general acerca de los recursos médicos comprobados con los que se cuenta en reumatología con el objeto de desalentar el empleo de los no comprobados y llamar la atención de las autoridades sanitarias sobre este problema