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      Análise descritiva das características demográficas e clínicas de pacientes com artrite reumatóide no estado de São Paulo, Brasil Translated title: Descriptive analysis of the demographical and clinical characteristics of the patients with rheumatoid arthritis in the State of São Paulo, Brazil

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          OBJETIVO: realizar uma análise retrospectiva das características demográficas e clínicas de pacientes com artrite reumatóide (AR), em acompanhamento ambulatorial no Estado de São Paulo, Brasil. MÉTODOS: foram revisados 1.381 prontuários de pacientes com artrite reumatóide, atendidos entre 2002 e 2005. Os prontuários foram transcritos em protocolos padronizados, coletando-se idade, sexo, raça, peso corpóreo, tempo de doença, gravidade da doença, classificação do estado funcional, fator reumatóide, condição social, presença de dor na última consulta, avaliação de progressão radiológica, envolvimento extra-articular, emprego de questionários de Qualidade de Vida ou de Atividade da Doença, tipos de tratamentos e de programa de reabilitação. RESULTADOS: dos 1.381 pacientes, 86% eram mulheres, caucasianas, estavam entre a quarta e quinta década, tempo médio de doença de 7,2 anos e o peso corpóreo médio de 65,6 kg. Uma minoria (5%) foi classificada como grave, e a maioria apresentava classe funcional I e II. As manifestações extra-articulares ocorreram em 23,3%, e o fator reumatóide era positivo em 71% dos pacientes. Somente um terço possuía acompanhamento radiológico e estava trabalhando. O medicamento mais utilizado foi o metotrexato (dose 15-19 mg/semana). Um quarto dos pacientes estava freqüentando programas de reabilitação, e um terço possuía avaliações de qualidade de vida e de atividade da doença. CONCLUSÃO: essa análise proporcionou uma visão parcial dos pacientes brasileiros com AR, identificando pontos importantes em relação às características demográficas e clínicas, os tipos de tratamentos farmacológicos e a pequena utilização de marcadores de doença e questionários de qualidade de vida, bem como a limitação de serviços de reabilitação disponíveis para os pacientes.

          Translated abstract

          OBJECTIVE: to perform a retrospective analysis of clinical and demographic characteristics of rheumatoid arthritis (RA) patients followed in outpatient clinics in the State of São Paulo, Brazil. METHODS: 1.381 medical records of rheumatoid arthritis patients were reviewed in the period between 2002 and 2005. These data were analyzed using a standardized form, based on the following parameters: sex, age, race, weight, follow-up time, disease progression, functional status, rheumatoid factor positivity, social status, pain in the last visit, radiologic progression, extra-articular manifestations, quantitative assessment of functional status and disease active score (DAS), pharmacological treatment, and physical therapy. RESULTS: 86% were female Caucasians. Age of disease onset varied between the forth and fifth decades. Mean follow-up was 7.2 years and mean body weight was 65.6 kg. Less than 5% of the patients were classified as severe and the majority of the patients presented functional class I and II. Extra-articular manifestations were observed in 23.3% and the rheumatoid factor was positive in 71%. Only 33% of the patients had radiological evaluation and were working regularly. Methotrexate was the most common medication (15-19 mg/week). Only 25% of these patients were attending physical therapy and 30% had quantitative assessment of functional status and DAS. CONCLUSION: this analysis provided a partial analysis of the RA Brazilian population, identified demographic and clinical characteristics, the therapeutic drugs used, and the difficulty of the patients in attending rehabilitation services.

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          Predicting mortality in patients with rheumatoid arthritis.

          A number of different variables have been proposed as risk factors for mortality in patients with rheumatoid arthritis (RA), but limited prospective information on the magnitude of their effects is available. This study was undertaken to evaluate the relative predictive strength and usefulness of a wide range of variables on the risk of mortality in a large, long-term, prospectively studied cohort of patients with RA. Over a 20-year period of followup beginning in 1981, 1387 consecutive RA patients were seen in a single clinic. A wide range of clinical and demographic assessments were recorded and entered into a computer database at the time of each clinical assessment. Assessment of predictive strength included determination of standardized and fourth-versus-first-quartile odds ratios (ORs), goodness-of-fit measures, and contributing fraction. The Health Assessment Questionnaire (HAQ) disability index was the strongest clinical predictor of mortality. A 1-SD change in the HAQ resulted in a much larger increase in the odds ratio for mortality compared with a 1-SD change in global disease severity, the next most powerful predictor of mortality (OR 2.31 versus 1.83). Considering the contributing fraction, mortality would be reduced by 50% for the HAQ and by 33% for global disease severity if patients in the fourth quartile for these variables could be switched to the first quartile. Global disease severity, pain, depression, anxiety, and laboratory and radiographic features were significantly weaker predictors. Disease duration, nodules, and tender joint count were clinical variables that provided very little predictive information. In multivariable analyses, HAQ and other patient self-report measures were significantly better predictors than were radiographic and laboratory variables. A single baseline observation provided the least information, with substantially increasing predictive ability associated with 1-year, 2-year, and all-time point followup observations (time-varying covariates). In this large 20-year study from routine clinical practice, the HAQ was the most powerful predictor of mortality, followed by other patient self-report variables. Laboratory, radiographic, and physical examination data were substantially weaker in predicting mortality. We recommend that clinicians collect patient self-report data, since they produce more useful clinical outcome information than other available clinical measures.
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            Stratifying the risk of NSAID-related upper gastrointestinal clinical events: results of a double-blind outcomes study in patients with rheumatoid arthritis.

            Epidemiologic data indicate that the risk of nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) clinical events varies based on patients' clinical characteristics. The authors determined risk factors for NSAID-related clinical upper GI events and the event rates, absolute risk reductions, and numbers needed to treat for individual risk factors for a nonselective NSAID and a selective cyclooxygenase 2 inhibitor in a double-blind outcomes trial. Eight thousand seventy-six rheumatoid arthritis patients aged >or=50 years (or >or=40 on corticosteroid therapy) were randomly assigned to rofecoxib 50 mg daily or naproxen 500 mg twice daily for a median of 9 months. The development of clinical upper GI events (bleeding, perforation, obstruction, and symptomatic ulcer identified on clinically indicated work-up) was assessed. Significant risk factors included prior upper GI events, age >or=65, and severe rheumatoid arthritis (RR, 2.3-3.9). Patients administered naproxen who had prior upper GI complications or who were aged >or=75 years had 18.84 or 14.46 events per 100 patient-years, and the risk of events remained constant over time. The reduction in events with rofecoxib was similar in high- and low-risk subgroups (RR, 0.31-0.68). The number needed to treat with rofecoxib instead of naproxen to avert 1 GI event was 10-12 in highest risk patients (prior event, age >or=75 years, or severe rheumatoid arthritis), 17-33 in patients with other risk factors, and 42-106 in low-risk patients. NSAID-related GI events increase dramatically with risk factors such as prior events or older age. Ten to twelve high-risk patients need to be treated with a protective strategy such as the selective cyclooxygenase 2 inhibitor, rofecoxib, to avert a clinical GI event.
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              THE INCIDENCE OF RHEUMATOID ARTHRITIS IN THE UNITED KINGDOM: RESULTS FROM THE NORFOLK ARTHRITIS REGISTER

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rbr
                Revista Brasileira de Reumatologia
                Rev. Bras. Reumatol.
                Sociedade Brasileira de Reumatologia (São Paulo )
                1809-4570
                April 2007
                : 47
                : 2
                : 84-90
                Affiliations
                [1 ] Universidade de São Paulo Brazil
                [2 ] Santa Casa de Misericórdia de São Paulo Brazil
                [3 ] Faculdade de Medicina de São José do Rio Preto
                [4 ] Universidade Federal de São Paulo Brazil
                Article
                S0482-50042007000200002
                10.1590/S0482-50042007000200002
                a044fa55-c9f4-4a4b-968d-f0aec50b4c36

                http://creativecommons.org/licenses/by/4.0/

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                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0482-5004&lng=en
                Categories
                RHEUMATOLOGY

                Rheumatology
                rheumatoid arthritis,São Paulo,patients,artrite reumatóide,pacientes
                Rheumatology
                rheumatoid arthritis, São Paulo, patients, artrite reumatóide, pacientes

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