Decreasing delays in the diagnosis and treatment of rheumatoid arthritis in Brazil: a nationwide multicenter observational study
Adv Rheumatol
;
63: 3, 2023. tab, graf
Artículo
en Inglés
|
LILACS-Express
| LILACS
| ID: biblio-1447136
ABSTRACT
Abstract Background Management delays imply worse outcomes in rheumatoid arthritis (RA) and, therefore, should be minimized. We evaluated changes in diagnostic and treatment delays regarding RA in the last decades in Brazil. Methods Adults fulfilling the ACR/EULAR (2010) criteria for RA were assessed. Delays in diagnosis and treatment, and the frequencies of early management initiation within thresholds (windows of opportunity) of 3, 6, and 12 months from symptoms onset were evaluated. The Mann-Kendall trend test, chi-squared tests with Cramer's V effect sizes and analysis of variance were conducted. Results We included 1116 patients 89.4% female, 56.8% white, mean (SD) age 57.1 (11.5) years. A downward trend was found in diagnostic (tau = - 0.677, p < 0.001) and treatment (tau = - 0.695, p < 0.001) delays from 1990 to 2015. The frequency of early management increased throughout the period, with ascending effect sizes across the 3-, 6-, and 12-month windows (V = 0.120, 0.200 and 0.261, respectively). Despite all improvements, even in recent years (2011-2015) the diagnostic and treatment delays still remained unacceptably high [median (IQR) 8 (4-12) and 11 (5-17) months, respectively], with only 17.2% of the patients treated within the shortest, 3-month window. Conclusion The delays in diagnosis and treatment of RA decreased during the last decades in Brazil. Improvements (effect sizes) were greater at eliminating extreme delays (≥ 12 months) than in attaining really short management windows (≤ 3 months). Very early treatment was still an unrealistic goal for most patients with RA.
Texto completo:
Disponible
Índice:
LILACS (Américas)
Tipo de estudio:
Ensayo Clínico Controlado
/
Estudio diagnóstico
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Estudio observacional
País/Región como asunto:
America del Sur
/
Brasil
Idioma:
Inglés
Revista:
Adv Rheumatol
Asunto de la revista:
Artrite
/
Reumatologia
Año:
2023
Tipo del documento:
Artículo
País de afiliación:
Brasil
Institución/País de afiliación:
Campus Universitário Darcy Ribeiro/BR
/
Centro Universitário de Brasília/BR
/
Hospital das Clínicas/BR
/
Hospital do Servidor Público Estadual de São Paulo/BR
/
Universidade Estadual de Campinas/BR
/
Universidade Federal de Minas Gerais/BR
/
Universidade Federal de Santa Catarina/BR
/
Universidade Federal do Paraná/BR
/
Universidade Federal do Pará/BR
/
Universidade Federal do Rio Grande do Sul/BR
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