Banca de DEFESA: CLEANDRO PIRES DE ALBUQUERQUE

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
STUDENT : CLEANDRO PIRES DE ALBUQUERQUE
DATE: 12/04/2023
TIME: 14:30
LOCAL: Plataforma TEAMS - online
TITLE:

“Long-term effectiveness of early rheumatoid arthritis treatment under real life in brazil”

KEY WORDS:

Rheumatoid Arthritis, Delivery of Health Care, Health Services Accessibility, Patient Outcome Assessment, Treatment Outcome

PAGES: 129
BIG AREA: Ciências da Saúde
AREA: Medicina
SUMMARY:

Background: Early treatment (within 3 months of symptoms, ideally) and tight disease control are fundamentals in the management of rheumatoid arthritis (RA), although not always achievable in real life. Objectives: To assess the delays in diagnosis and treatment of RA, in Brazil, and the long-term effects of early access to the rheumatologist, early treatment and mode of disease control (tight vs. standard) regarding RA after long disease duration, under real-life conditions. Methods: Adults meeting (ACR/EULAR 2010) criteria for RA, from 11 Brazilian hospitals were recruited between August/2015 and April/2016 to this follow-up study. Clinical features, disease activity (DAS28), physical function (HAQ), erosive disease, diagnostic and therapeutic delays, mode of disease control (tight vs. standard) and the specialties of the physicians who first consulted the patient (upon symptoms onset) and who established the diagnosis were evaluated. Chi-squared, students’ t, Mann-Whitney’s U, ANOVA, correlation, Mann-Kendall’s trend tests and multiple regression models (significance level: 0.05) were conducted in SPSS 25 e R 3.6.2. The study received ethical approval; all participants granted informed consent. Results: 1116 participants were included; women: 89.4%; white race: 56.8%; mean (SD) age: 57.5 (11.5) years; disease duration: 174.9 (115.0) months; disease activity (DAS28): 3.62 (1.52); physical function (HAQ): median [Q1; Q3] = 0.875 [0.250; 1.500]; erosive disease found in 54.9%; positive rheumatoid factor in 78.6%. Downtrends in diagnostic (tau = -0.677, p < 0.001) and therapeutic (tau = -0.695, p < 0.001) delays were observed since from 1990. However, in the years 2011-2015, the median [Q1; Q3] therapeutic delay was still 11 [5; 17] months. In 80.7%, RA diagnosis was established only by the rheumatologist. Early access to the rheumatologist was associated with early treatment (OR 2.57 [1.54; 4.27]; p<0.001) and, in the long term, with lower disease activity (DAS28 difference in means [95%CI]: -0.25 [-0.46; -0.04]; p = 0.020) and better physical function (HAQ: -0.20 [-0.31; -0.09]; p < 0.001). Early treatment (in bivariate analyses) was associated with lower disease activity, better physical function and less erosive disease, however losing significance (p ≥ 0.05) after adjustments for age, schooling and disease duration. Tight disease control was associated, in the long term, with less corticosteroid (χ2 = 59.1; p < 0.001) and biologics usage (χ2 =10.2; p = 0.017), less erosive disease (χ2 = 32.1; p <0.001), higher remission rates (χ2 =14.4; p = 0.002) and lower DAS28 (F = 3.44; p = 0.018) and HAQ (F = 5.2; p = 0.002) scores. Conclusions: The delays in diagnosis and treatment of RA diminished in Brazil over the last decades, although substantial delays were still observed. The diagnosis of RA was highly dependent on the rheumatologist. Early access to the rheumatologist was associated with better clinical outcomes in the long run. Early treatment when adjusted for confounders could not predict better long-term clinical outcomes; tight disease control, nevertheless, was associated with lower disease activity, better physical function and less radiographic damage under real-life conditions.

BANKING MEMBERS:
Externa à Instituição - ANGELA LUZIA BRANCO PINTO DUARTE - UFPE
Externa à Instituição - CLARISSA DE CASTRO FERREIRA - ESCS
Interna - 1286342 - LAILA SALMEN ESPINDOLA
Presidente - 141.787.884-34 - LEOPOLDO LUIZ DOS SANTOS NETO - UnB
Externa à Instituição - LUCIANA FEITOSA MUNIZ - SÍRIO