High Levels of Polypharmacy in Rheumatoid Arthritis-A Challenge Not Covered by Current Management Recommendations: Data From a Large Real-Life Study.

BACKGROUND: Rheumatoid arthritis (RA) is associated with high frequency of comorbidities and increased risk of polypharmacy. Although there is a great potential for complications, there is a gap in literature on polypharmacy in patients with rheumatic arthritis. OBJECTIVE: To evaluate the prevalence and factors associated with polypharmacy in a population in a real-life setting. METHODS: A cross-sectional multicenter study was conducted in Brazil. Patients underwent clinical evaluation and medical records analysis. Polypharmacy was considered as a dependent variable. To test independent variables, we used Poisson regression. RESULTS: We evaluated 792 patients (89% female, median age 56.6 years). Median duration of disease was 12.7 years, 78.73% had a positive rheumatoid factor. The median of disease activity score-28 was 3.5 (disease with mild activity), median of the clinical disease activity index score was 9, and median of health assessment questionnaire-disability index was 0.875; 47% used corticosteroids, 9.1% used nonsteroidal anti-inflammatory drugs, 90.9% used synthetic disease-modifying antirheumatic drugs, 35.7% used biologic disease-modifying antirheumatic drugs (DMARDs). In total, 537 (67.9%) patients used 5 or more drugs. Polypharmacy showed a relationship with a number of comorbidities and use of specific drugs (corticosteroids, methotrexate, and biological DMARDs). CONCLUSION: We found a high prevalence of polypharmacy (67.9%) in RA. Solutions to management this problem should be stimulated.

Fertility and acidity status of latossolos (oxisols) under pasture in the Brazilian Cerrado.

The Cerrado region, with over 50 million hectares of cultivated pasture, provides 55% of Brazilian beef production. Previous investigations have shown that about 70-80% of this pasture is affected by some kind of degradation, leading to low productivity. However, until now, few surveys have been carried out on a regional scale. The aim of the present work is both to assess the fertility and acidity levels of Cerrado soils under pasture and compare the variability of the soils characteristics on a regional scale. Two soil depths were sampled in different places within the studied area: (1) a surface horizon (0.0-0.2 m) in order to evaluate its fertility and acidity status for pasture, and (2) a subsurface horizon (0.6-0.8 m), used for classification. Most of soils had levels of nutrients below the reference values for adequate pasture development. Whatever the texture, about 90% of soils had low or very low availability of phosphorus. Only 7 to 14% of soils had low pH, high exchangeable aluminum, and aluminum saturation above the critical acidity level. Except for nitrogen, no significant difference was found between Latossolos Vermelhos and Latossolos Vermelho-Amarelos.

Fertility and acidity status of latossolos (oxisols) under pasture in the Brazilian Cerrado

The Cerrado region, with over 50 million hectares of cultivated pasture, provides 55 percent of Brazilian beef production. Previous investigations have shown that about 70-80 percent of this pasture is affected by some kind of degradation, leading to low productivity. However, until now, few surveys have been carried out on a regional scale. The aim of the present work is both to assess the fertility and acidity levels of Cerrado soils under pasture and compare the variability of the soils characteristics on a regional scale. Two soil depths were sampled in different places within the studied area: (1) a surface horizon (0.0-0.2 m) in order to evaluate its fertility and acidity status for pasture, and (2) a subsurface horizon (0.6-0.8 m), used for classification. Most of soils had levels of nutrients below the reference values for adequate pasture development. Whatever the texture, about 90 percent of soils had low or very low availability of phosphorus. Only 7 to 14 percent of soils had low pH, high exchangeable aluminum, and aluminum saturation above the critical acidity level. Except for nitrogen, no significant difference was found between Latossolos Vermelhos and Latossolos Vermelho-Amarelos.

A região do Cerrado, com 50 milhões de hectares de pastagens cultivadas, responde por 55 por cento da carne bovina produzida no Brasil. Há estimativas indicando que entre 70 e 80 por cento destas pastagens apresentam algum grau de degradação, o que leva a baixa produtividade. No entanto, até o presente, poucos trabalhos foram desenvolvidos em escala regional. O objetivo deste trabalho foi avaliar a fertilidade e a acidez de Latossolos sob pastagens na região do Cerrado e comparar a variabilidade das características dos solos em escala regional. A amostragem foi realizada em duas profundidades, superficial (0,0-0,2 m) para avaliação da fertilidade e acidez e subsuperficial (0,60,8 m), utilizada para classificar os solos. A maioria dos solos apresentou teores de nutrientes abaixo do recomendado para o adequado desenvolviento das pastagens. Independentemente da textura, aproximadamente 90 por cento dos solos apresentaram baixa ou muito baixa disponibilidade de P. Apenas 7-14 por cento dos solos apresentaram baixo pH, alta saturação por Al e acidez acima do nível crítico. Exceto para o N, não houve diferença significativa nos níveis de fertilidade e acidez entre os Latossolos Vermelhos e os Latossolos Vermelho-Amarelos.