Decreasing delays in the diagnosis and treatment of rheumatoid arthritis in Brazil: a nationwide multicenter observational study

Advances in Rheumatology

Research

Sebastião Cezar Radominski¹  Claiton Viegas Brenol²  Karina Rossi Bonfiglioli³  Maria de Fátima L. da Cunha Sauma⁴  Maria Fernanda B. Resende Guimarães⁵  Ivânio Alves Pereira⁶  Ana Beatriz Vargas Santos⁷  Geraldo R. Castelar Pinheiro⁷  Rina Dalva Neubarth Giorgi⁸  Manoel Barros Bértolo⁹  Cleandro Pires de Albuquerque^1,10  Leopoldo Santos-Neto^1,10  Licia Maria Henrique da Mota^1,10  Ana Paula Monteiro Gomides Reis^1,11  Paulo Louzada Júnior^1,12 

[1] Department of Internal Medicine, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil;Department of Internal Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil;Department of Rheumatology, Hospital das Clínicas, USP, São Paulo, SP, Brazil;Department of Rheumatology, School of Medicine, Universidade Federal do Pará, Belém, PA, Brazil;Department of Rheumatology, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil;Department of Rheumatology, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil;Department of Rheumatology, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil;Instituto de Assistência Médica ao Servidor Público Estadual, Hospital do Servidor Público Estadual de São Paulo (IAMSPE), São Paulo, SP, Brazil;Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil;Rheumatology Service, Universidade de Brasília (UnB), Campus Universitário Darcy Ribeiro, 70910-900, Brasília, DF, Brazil;School of Medicine, Centro Universitário de Brasília (CEUB), Brasília, DF, Brazil;School of Medicine, Universidade de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil;

关键词: Rheumatoid arthritis;    Therapeutics;    Epidemiology;    Outcome and process assessment;    Health care;   

DOI  :  10.1186/s42358-022-00265-0

 received in 2022-05-20, accepted in 2022-08-07,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundManagement 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.MethodsAdults 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.ResultsWe 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.ConclusionThe 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.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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