The epidemiology of rheumatoid arthritis in a cohort of Colombian patients

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"idiomaDefecto" => true "cabecera" => "Original Investigation" "titulo" => "The epidemiology of rheumatoid arthritis in a cohort of Colombian patients" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "148" "paginaFinal" => "152" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Jorge Enrique Machado-Alba, Andrés Felipe Ruiz, Diego Alejandro Medina Morales" "autores" => array:3 [ 0 => array:3 [ "nombre" => "Jorge Enrique" "apellidos" => "Machado-Alba" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Andrés Felipe" "apellidos" => "Ruiz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "Diego Alejandro" "apellidos" => "Medina Morales" "email" => array:1 [ 0 => "machado@utp.edu.co" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Director Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A. Pereira, Colombia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Director Farmacoeconomía-Audifarma S.A. Bogotá, Colombia" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Facultad Ciencias de la Salud, Universidad Tecnológica de Pereira-Audifarma, S.A., Pereira, Colombia" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Epidemiología de la artritis reumatoide en una cohorte de pacientes colombianos" ] ] "textoCompleto" => "IntroductionRheumatoid arthritis (RA) is a chronic disease characterized by inflammation, pain, the destruction of synovial joints and systemic manifestations including cardiovascular, lung, bone and psychological involvements which lead to severe disability and premature mortality.<a class="elsevierStyleCrossRefs" href="#bib0090">1–4</a> It is considered an autoimmune disease because of the presence of autoantibodies such as rheumatoid factor (RF) and anti-citrullinated peptides (ACPA) or (cyclic citrullinated peptide [anti-CCPs] antibodies) that may be found and precede clinical manifestations of the disease by several years.<a class="elsevierStyleCrossRef" href="#bib0090">1</a> The prevalence for RA is estimated at 0.8–1.0% across the general population, affecting 2–4 times more women than men. Its prevalence increases with age and gender differences decrease.<a class="elsevierStyleCrossRefs" href="#bib0100">3–7</a> It is estimated that the incidence in the United States is at 25 per 100,000 men and 54 per 100,000 women, which means that about 2.1 million people have the disease. Most European and North American studies estimate an average annual incidence of 0.02–0.05%.<a class="elsevierStyleCrossRef" href="#bib0125">8</a> The age of onset is usually between 30 and 50 years old and this is related to the interaction of environmental agents and the person's individual genetic predisposition.<a class="elsevierStyleCrossRefs" href="#bib0100">3,4,6,7</a> Juvenile RA and the elderly-onset RA (older than 65 years old) may also occur.<a class="elsevierStyleCrossRef" href="#bib0120">7</a>In Colombia little available data exists that characterizes RA and variables related to its clinical behavior. The study attempted to determine socio-demographics, clinical, paraclinical and pharmacological variables in a cohort of patients diagnosed with RA in five cities.Materials and methodsTaking as a base a population of 858,045 patients from the contributory scheme of the Health System of Colombia (SGSSS), Health Assurance Company (EPS) affiliates was selected from all ages and both genders with a diagnostic in medical record that included the words “rheumatoid arthritis.” This was carried out in five of Colombia's main cities (Bogotá, Cali, Manizales, Medellin, and Pereira) in patients who had been treated at the Service Providing Institution in the application of medications (IPS-Especializada de Audifarma S.A.) between December 2009 and August 2013. Diagnoses according to the International Classification of Diseases (ICD-10), were: (1) Rheumatoid arthritis, unspecified (M069). (2) Arthritis, unspecified (M159). (3) Seropositive rheumatoid arthritis, not otherwise specified (M059). (4) Juvenile arthritis, unspecified (M080). (5) Seronegative rheumatoid arthritis (M060). (6) Juvenile rheumatoid arthritis (M080). (7) Other seropositive rheumatoid arthritis (M058) and (8) Other specified rheumatoid arthritis (M068). All diagnoses were made by physician who specializes in rheumatology.Information was obtained by a team of four physicians trained for this purpose and the data was reviewed and audited by a pharmacoepidemiologist who recorded them in an Excel database for initial analysis. The following variables were considered: socio-demographic: age, gender, educational level. Clinical: specific diagnosis according to the ICD-10, age of the onset of symptoms, age at moment of diagnosis, progression time of the disease, DAS-28 mean, comorbidities. Pharmacological: the international non-proprietary name (generic) of disease-modifying antirheumatic drug (DMARDs) which were being received. Behavioral factors were also described such as those who were smokers and the active consumption of alcohol (yes/no).Information from the Excel® database was analyzed using IBM-SPSS 22.0 software for Windows (IBM Chicago Illinois, USA). Data was expressed in frequencies and percentages. The study was classified as non-risk research and received endorsement from the Universidad Tecnológica de Pereira's Bioethics Committee, under Ministry of Health Resolution 8430 of 1993 that sets forth the principles of scientific research according to the Declaration of Helsinki.ResultsA total of 1364 patients were found that complied with the inclusion criteria. The estimated disease prevalence was 0.15%. General results showed that the average age of patients was 53.2±13.9 years old. 81.8% of patients were women. The male:female ratio was 4.5:1.0. The average age for the onset of symptoms was 41.3 years old and the average time of disease duration was 116 months (data from 710 patients where the date at which symptoms started was established). Most people had only attained a basic primary education level. A very low percentage of patients admitted to being smokers or consumers of alcoholic drinks. In 87 (55.8%) of 156 patients who had information on X-rays of hands or feet erosions were found. The most common diagnoses in order of frequency were: seropositive RA, unspecified RA and seronegative RA (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The average DAS-28 at the beginning of the cohort was 3.43. Remission was found in 20.2% (n=216) of patients, while 39.7% (n=425) had mild, 34.6% (n=370) moderate and 5.5% (n=59) to high disease activity. The most common comorbidities included: osteoporosis, high blood pressure, dyslipidemia and other autoimmune diseases (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Methotrexate was the most prescribed DMARD followed by Prednisolone, Leflunomide, Chloroquine and Sulfasalazine (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>DiscussionAs part of the study, data for the distribution of various variables were obtained in individuals diagnosed with RA across five of Colombia's main cities between 2009 and 2013. Since there are no population databases that estimate the prevalence of the disease in the country, these findings provide important information regarding the understanding of this condition. Discovering that 0.15% of this population has or is being treated for RA is an indicator that may reflect an under-diagnosis of the disease and that few patients have easy and timely access to treatment. Furthermore, the disease's prevalence in Colombia is lower than in other countries where statistics have estimated that the prevalence is between 0.5% and 1.0% of the population, although the incidence of the disease has shown variations depending on geographical location.<a class="elsevierStyleCrossRefs" href="#bib0130">9,10</a>While international literature shows that the disorder is three times more common in females, in this study's cohort it was found that this figure was 4.5 times more common in women than in men. More research is needed in order to explain this difference.<a class="elsevierStyleCrossRefs" href="#bib0130">9,11,12</a> Differences were also found in the age of patients as this cohort was younger than those reported in Albania (53.2 vs. 62.4 years old),<a class="elsevierStyleCrossRef" href="#bib0140">11</a> but older than those reported in Greece (46.8 years old),<a class="elsevierStyleCrossRef" href="#bib0150">13</a> while the progress time of the disease is also slightly higher than the figure reported by Kirchhoff et al. (9.6 years old in Colombia vs. 8.0 years old in Germany).<a class="elsevierStyleCrossRef" href="#bib0155">14</a> No available data was found on comorbidities that accompanied the patient with RA. However, association with osteoporosis, high blood pressure and dyslipidemia are not surprising because there have already been reports across the country of patients with these morbidities and the use of anti-inflammatory drugs.<a class="elsevierStyleCrossRefs" href="#bib0160">15,16</a> The use of DMARDs such as Methotrexate and Leflunomide as the most prescribed examples is consistent throughout the literature which supports its use as a first-line of treatment and leaves biotechnology drug products as alternatives in managing refractory patients.<a class="elsevierStyleCrossRefs" href="#bib0100">3,4,7,14,17</a>According to the above, these findings are related to some extent with data published by other authors, however, this study in the country to use a large cohort, valuable information is provided that establishes clinical characteristics, disease behavior, comorbidities and medication trends in Colombia, allowing the epidemiological profile of patients with RA to be determined.This study has several limitations that must be recognized, among them the study population included only patients with a specific institution and for certain variables analyzed no information available in the medical record and the ICD-10 considered can create a selection bias.Since information was obtained from patients affiliated to just one insurer covering about 5.0% of the Colombian population, results may only be extrapolated to groups with equal insurance conditions. Therefore more studies are needed so as to estimate across all population groups in the country what the disease's incidence and prevalence is, how patients are being treated and what the costs of this care are.Ethical responsibilitiesProtection of human and animal subjectsThe authors declare that no experiments were performed on humans or animals for this investigation.Confidentiality of DataThe authors declare that no patient data appears in this article.Right to privacy and informed consentThe authors declare that no patient data appears in this article.Sources of fundingUniversidad Tecnológica de Pereira, Audifarma S.A. Grant number: 2012-13Conflicts of interestThe authors declare that Pfizer Colombia financed the data collection process in medical records. There was no intervention in the stages of processing, analysis or publication of that data." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres574477" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec591401" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres574476" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec591402" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0035" "titulo" => "Ethical responsibilities" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Confidentiality of DataThe authors declare that no patient data appears in this article.Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0055" "titulo" => "Sources of funding" ] 10 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-02-23" "fechaAceptado" => "2015-05-29" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec591401" "palabras" => array:6 [ 0 => "Anti-rheumatic agents" 1 => "Juvenile arthritis" 2 => "Rheumatoid arthritis" 3 => "Epidemiology" 4 => "Methotrexate" 5 => "Colombia (DeCS)" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec591402" "palabras" => array:6 [ 0 => "Agentes antirreumáticos" 1 => "artritis juvenil" 2 => "artritis reumatoide" 3 => "epidemiología" 4 => "metotrexate" 5 => "Colombia (DeCS)" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "BackgroundRheumatoid arthritis (RA) is a chronic autoimmune disease with an estimated prevalence of between 0.8% and 1.0%. It is most common in women. Epidemiological RA data in Colombia is scarce. The objective was to determine epidemiological and pharmacological characteristics of a population diagnosed with RA across 5 Colombian cities between the years 2009 and 2013. MethodsA descriptive study was developed that used information from medical records at a rheumatology patients care facility. The records were identified according to the keywords “rheumatoid arthritis”. The socio-demographic, clinical, para-clinical and pharmacological variables were then recorded. The analysis was performed using IBM SPSS-22.0 software. ResultsOut of a total of 1364 patients, disease prevalence was estimated at 0.15%, with a mean age of 53.2±13.9. The symptoms started at 41.3±14.0 years old, and 81.9% were women. The DAS-28 (Disease Activity Score in 28 joints) mean was 3.46, and 12.9% of the patients were smokers. Osteoporosis (32.3% of patients) and high blood pressure (32.1%) were the most common comorbidities, while methotrexate was the most prescribed medication (98.4%). ConclusionsThis is the first study in Colombia to use a large cohort in order to gather valid information that establishes clinical characteristics, disease behavior, comorbidities, and medication trends in the country." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "AntecedentesLa artritis reumatoide (AR) es una enfermedad crónica autoinmune, cuya prevalencia se estima en 0,8–1,0% y es más frecuente en mujeres. Los datos epidemiológicos sobre AR en Colombia son escasos. El objetivo fue determinar las características epidemiológicas y farmacológicas de una población con diagnóstico de AR, en 5 ciudades de Colombia, durante los años 2009 a 2013. MétodosSe realizó un estudio descriptivo a partir de la información de historias clínicas de una institución de atención a pacientes reumatológicos. Se identificaron según la palabra clave artritis reumatoide y se identificaron las variables socio-demográficas, clínicas, paraclínicas y farmacológicas. El análisis se hizo mediante IBM-SPSS 22.0. ResultadosDe un total de 1.364 pacientes, se estimó una prevalencia de enfermedad de 0,15%, con edad promedio 53,2±13,9 años y de inicio de síntomas 41,3±14,0 años. El 81,9% fue de sexo femenino. La media de DAS-28 fue 3,46. El 12,9% de pacientes era fumador. La osteoporosis (32,3% de pacientes) e hipertensión arterial (32,1%) fueron las comorbilidades más frecuentes y metotrexate (98.4%) el medicamento más prescrito. ConclusionesEs el primer estudio en Colombia que utiliza una cohorte amplia y aporta información válida que establece las características clínicas, comportamiento de la enfermedad, comorbilidades y tendencias de la medicación en el país." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Frequency (n=1364) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Age (mean±SD), years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">53.2±13.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Gender (female/male) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">1111/246 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">81.9/18.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Education level of 411 records (basic primary/secondary/university) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">242/96/73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">58.9/23.4/17.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Alcohol consumption (1030 records) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">2.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Smoking (1045 records) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">135 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">12.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="bottom"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="bottom">Diagnosis</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Seropositive RA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">781 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">57.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">RA, unspecified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">400 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">29.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Seronegative RA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">126 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">9.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Juvenile RA and Juvenile, Unspecified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">1.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Other \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">1.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Arthritis, unspecified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">0.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Without diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">0.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="bottom"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="bottom">Clinical</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Age at onset (mean±SD), years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">41.3±14.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Age at diagnosis (mean±SD), years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">43.1±14.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Disease progress (mean±SD), months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">116.0±91.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="bottom"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="bottom">Disease-modifying antirheumatic drug</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Methotrexate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">1343 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">98.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Prednisolone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">1246 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">91.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Leflunomide \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">979 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">71.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Chloroquine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">657 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">48.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Sulfasalazine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">515 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">37.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Deflazacort \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">288 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">21.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Etanercept \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">133 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">9.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Hydroxychloroquine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">113 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">8.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Abatacept \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">5.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Methylprednisolone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">5.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Adalimumab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">4.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Infliximab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">4.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="bottom"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="bottom">Comorbidities</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Osteoporosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">440 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">32.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">High blood pressure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">438 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">32.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Dyslipidemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">327 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">24.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Other autoimmune diseases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">139 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">10.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Diabetes mellitus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">6.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Chronic Obstructive Pulmonary Disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">4.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="bottom">Congestive Heart Failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="bottom">1.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab937828.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of 1364 patients with rheumatoid arthritis in Colombia, 2009–2013." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" 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Original Investigation

Epidemiología de la artritis reumatoide en una cohorte de pacientes colombianos

Jorge Enrique Machado-Albaa,*, Andrés Felipe Ruizb, Diego Alejandro Medina Moralesc

a Director Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A. Pereira, Colombia

b Director Farmacoeconomía-Audifarma S.A. Bogotá, Colombia

c Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Facultad Ciencias de la Salud, Universidad Tecnológica de Pereira-Audifarma, S.A., Pereira, Colombia

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Rheumatoid arthritis &#40;RA&#41; is a chronic disease characterized by inflammation&#44; pain&#44; the destruction of synovial joints and systemic manifestations including cardiovascular&#44; lung&#44; bone and psychological involvements which lead to severe disability and premature mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">1&#8211;4</span></a> It is considered an autoimmune disease because of the presence of autoantibodies such as rheumatoid factor &#40;RF&#41; and anti-citrullinated peptides &#40;ACPA&#41; or &#40;cyclic citrullinated peptide &#91;anti-CCPs&#93; antibodies&#41; that may be found and precede clinical manifestations of the disease by several years&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a> The prevalence for RA is estimated at 0&#46;8&#8211;1&#46;0&#37; across the general population&#44; affecting 2&#8211;4 times more women than men&#46; Its prevalence increases with age and gender differences decrease&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">3&#8211;7</span></a> It is estimated that the incidence in the United States is at 25 per 100&#44;000 men and 54 per 100&#44;000 women&#44; which means that about 2&#46;1 million people have the disease&#46; Most European and North American studies estimate an average annual incidence of 0&#46;02&#8211;0&#46;05&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">8</span></a> The age of onset is usually between 30 and 50 years old and this is related to the interaction of environmental agents and the person&#39;s individual genetic predisposition&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">3&#44;4&#44;6&#44;7</span></a> Juvenile RA and the elderly-onset RA &#40;older than 65 years old&#41; may also occur&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In Colombia little available data exists that characterizes RA and variables related to its clinical behavior&#46; The study attempted to determine socio-demographics&#44; clinical&#44; paraclinical and pharmacological variables in a cohort of patients diagnosed with RA in five cities&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">Taking as a base a population of 858&#44;045 patients from the contributory scheme of the Health System of Colombia &#40;SGSSS&#41;&#44; Health Assurance Company &#40;EPS&#41; affiliates was selected from all ages and both genders with a diagnostic in medical record that included the words &#8220;rheumatoid arthritis&#46;&#8221; This was carried out in five of Colombia&#39;s main cities &#40;Bogot&#225;&#44; Cali&#44; Manizales&#44; Medellin&#44; and Pereira&#41; in patients who had been treated at the Service Providing Institution in the application of medications &#40;IPS-Especializada de Audifarma S&#46;A&#46;&#41; between December 2009 and August 2013&#46; Diagnoses according to the International Classification of Diseases &#40;ICD-10&#41;&#44; were&#58; &#40;1&#41; Rheumatoid arthritis&#44; unspecified &#40;M069&#41;&#46; &#40;2&#41; Arthritis&#44; unspecified &#40;M159&#41;&#46; &#40;3&#41; Seropositive rheumatoid arthritis&#44; not otherwise specified &#40;M059&#41;&#46; &#40;4&#41; Juvenile arthritis&#44; unspecified &#40;M080&#41;&#46; &#40;5&#41; Seronegative rheumatoid arthritis &#40;M060&#41;&#46; &#40;6&#41; Juvenile rheumatoid arthritis &#40;M080&#41;&#46; &#40;7&#41; Other seropositive rheumatoid arthritis &#40;M058&#41; and &#40;8&#41; Other specified rheumatoid arthritis &#40;M068&#41;&#46; All diagnoses were made by physician who specializes in rheumatology&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Information was obtained by a team of four physicians trained for this purpose and the data was reviewed and audited by a pharmacoepidemiologist who recorded them in an Excel database for initial analysis&#46; The following variables were considered&#58; socio-demographic&#58; age&#44; gender&#44; educational level&#46; Clinical&#58; specific diagnosis according to the ICD-10&#44; age of the onset of symptoms&#44; age at moment of diagnosis&#44; progression time of the disease&#44; DAS-28 mean&#44; comorbidities&#46; Pharmacological&#58; the international non-proprietary name &#40;generic&#41; of disease-modifying antirheumatic drug &#40;DMARDs&#41; which were being received&#46; Behavioral factors were also described such as those who were smokers and the active consumption of alcohol &#40;yes&#47;no&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Information from the Excel<span class="elsevierStyleSup">&#174;</span> database was analyzed using IBM-SPSS 22&#46;0 software for Windows &#40;IBM Chicago Illinois&#44; USA&#41;&#46; Data was expressed in frequencies and percentages&#46; The study was classified as non-risk research and received endorsement from the <span class="elsevierStyleItalic">Universidad Tecnol&#243;gica de Pereira</span>&#39;s Bioethics Committee&#44; under Ministry of Health Resolution 8430 of 1993 that sets forth the principles of scientific research according to the Declaration of Helsinki&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0030" class="elsevierStylePara elsevierViewall">A total of 1364 patients were found that complied with the inclusion criteria&#46; The estimated disease prevalence was 0&#46;15&#37;&#46; General results showed that the average age of patients was 53&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;9 years old&#46; 81&#46;8&#37; of patients were women&#46; The <span class="elsevierStyleItalic">male&#58;female</span> ratio was 4&#46;5&#58;1&#46;0&#46; The average age for the onset of symptoms was 41&#46;3 years old and the average time of disease duration was 116 months &#40;data from 710 patients where the date at which symptoms started was established&#41;&#46; Most people had only attained a basic primary education level&#46; A very low percentage of patients admitted to being smokers or consumers of alcoholic drinks&#46; In 87 &#40;55&#46;8&#37;&#41; of 156 patients who had information on X-rays of hands or feet erosions were found&#46; The most common diagnoses in order of frequency were&#58; seropositive RA&#44; unspecified RA and seronegative RA &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The average DAS-28 at the beginning of the cohort was 3&#46;43&#46; Remission was found in 20&#46;2&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>216&#41; of patients&#44; while 39&#46;7&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>425&#41; had mild&#44; 34&#46;6&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>370&#41; moderate and 5&#46;5&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>59&#41; to high disease activity&#46; The most common comorbidities included&#58; osteoporosis&#44; high blood pressure&#44; dyslipidemia and other autoimmune diseases &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Methotrexate was the most prescribed DMARD followed by Prednisolone&#44; Leflunomide&#44; Chloroquine and Sulfasalazine &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">As part of the study&#44; data for the distribution of various variables were obtained in individuals diagnosed with RA across five of Colombia&#39;s main cities between 2009 and 2013&#46; Since there are no population databases that estimate the prevalence of the disease in the country&#44; these findings provide important information regarding the understanding of this condition&#46; Discovering that 0&#46;15&#37; of this population has or is being treated for RA is an indicator that may reflect an under-diagnosis of the disease and that few patients have easy and timely access to treatment&#46; Furthermore&#44; the disease&#39;s prevalence in Colombia is lower than in other countries where statistics have estimated that the prevalence is between 0&#46;5&#37; and 1&#46;0&#37; of the population&#44; although the incidence of the disease has shown variations depending on geographical location&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">While international literature shows that the disorder is three times more common in females&#44; in this study&#39;s cohort it was found that this figure was 4&#46;5 times more common in women than in men&#46; More research is needed in order to explain this difference&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">9&#44;11&#44;12</span></a> Differences were also found in the age of patients as this cohort was younger than those reported in Albania &#40;53&#46;2 vs&#46; 62&#46;4 years old&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a> but older than those reported in Greece &#40;46&#46;8 years old&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">13</span></a> while the progress time of the disease is also slightly higher than the figure reported by Kirchhoff et al&#46; &#40;9&#46;6 years old in Colombia vs&#46; 8&#46;0 years old in Germany&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">14</span></a> No available data was found on comorbidities that accompanied the patient with RA&#46; However&#44; association with osteoporosis&#44; high blood pressure and dyslipidemia are not surprising because there have already been reports across the country of patients with these morbidities and the use of anti-inflammatory drugs&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">15&#44;16</span></a> The use of DMARDs such as Methotrexate and Leflunomide as the most prescribed examples is consistent throughout the literature which supports its use as a first-line of treatment and leaves biotechnology drug products as alternatives in managing refractory patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">3&#44;4&#44;7&#44;14&#44;17</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">According to the above&#44; these findings are related to some extent with data published by other authors&#44; however&#44; this study in the country to use a large cohort&#44; valuable information is provided that establishes clinical characteristics&#44; disease behavior&#44; comorbidities and medication trends in Colombia&#44; allowing the epidemiological profile of patients with RA to be determined&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">This study has several limitations that must be recognized&#44; among them the study population included only patients with a specific institution and for certain variables analyzed no information available in the medical record and the ICD-10 considered can create a selection bias&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Since information was obtained from patients affiliated to just one insurer covering about 5&#46;0&#37; of the Colombian population&#44; results may only be extrapolated to groups with equal insurance conditions&#46; Therefore more studies are needed so as to estimate across all population groups in the country what the disease&#39;s incidence and prevalence is&#44; how patients are being treated and what the costs of this care are&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Ethical responsibilities</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Protection of human and animal subjects</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this investigation&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095"><span class="elsevierStyleBold">Confidentiality of Data</span>The authors declare that no patient data appears in this article&#46;Right to privacy and informed consent</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appears in this article&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Sources of funding</span><p id="par0090" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleGrantSponsor" id="gs1">Universidad Tecnol&#243;gica de Pereira</span>&#44; <span class="elsevierStyleGrantSponsor" id="gs2">Audifarma S&#46;A&#46;</span> Grant number&#58; 2012-13</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that Pfizer Colombia financed the data collection process in medical records&#46; There was no intervention in the stages of processing&#44; analysis or publication of that data&#46;</p></span></span>"
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            1 => "Juvenile arthritis"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Rheumatoid arthritis &#40;RA&#41; is a chronic autoimmune disease with an estimated prevalence of between 0&#46;8&#37; and 1&#46;0&#37;&#46; It is most common in women&#46; Epidemiological RA data in Colombia is scarce&#46; The objective was to determine epidemiological and pharmacological characteristics of a population diagnosed with RA across 5 Colombian cities between the years 2009 and 2013&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A descriptive study was developed that used information from medical records at a rheumatology patients care facility&#46; The records were identified according to the keywords &#8220;rheumatoid arthritis&#8221;&#46; The socio-demographic&#44; clinical&#44; para-clinical and pharmacological variables were then recorded&#46; The analysis was performed using IBM SPSS-22&#46;0 software&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Out of a total of 1364 patients&#44; disease prevalence was estimated at 0&#46;15&#37;&#44; with a mean age of 53&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;9&#46; The symptoms started at 41&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;0 years old&#44; and 81&#46;9&#37; were women&#46; The DAS-28 &#40;Disease Activity Score in 28 joints&#41; mean was 3&#46;46&#44; and 12&#46;9&#37; of the patients were smokers&#46; Osteoporosis &#40;32&#46;3&#37; of patients&#41; and high blood pressure &#40;32&#46;1&#37;&#41; were the most common comorbidities&#44; while methotrexate was the most prescribed medication &#40;98&#46;4&#37;&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">This is the first study in Colombia to use a large cohort in order to gather valid information that establishes clinical characteristics&#44; disease behavior&#44; comorbidities&#44; and medication trends in the country&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La artritis reumatoide &#40;AR&#41; es una enfermedad cr&#243;nica autoinmune&#44; cuya prevalencia se estima en 0&#44;8&#8211;1&#44;0&#37; y es m&#225;s frecuente en mujeres&#46; Los datos epidemiol&#243;gicos sobre AR en Colombia son escasos&#46; El objetivo fue determinar las caracter&#237;sticas epidemiol&#243;gicas y farmacol&#243;gicas de una poblaci&#243;n con diagn&#243;stico de AR&#44; en 5 ciudades de Colombia&#44; durante los a&#241;os 2009 a 2013&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio descriptivo a partir de la informaci&#243;n de historias cl&#237;nicas de una instituci&#243;n de atenci&#243;n a pacientes reumatol&#243;gicos&#46; Se identificaron seg&#250;n la palabra clave artritis reumatoide y se identificaron las variables socio-demogr&#225;ficas&#44; cl&#237;nicas&#44; paracl&#237;nicas y farmacol&#243;gicas&#46; El an&#225;lisis se hizo mediante IBM-SPSS 22&#46;0&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">De un total de 1&#46;364 pacientes&#44; se estim&#243; una prevalencia de enfermedad de 0&#44;15&#37;&#44; con edad promedio 53&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;9 a&#241;os y de inicio de s&#237;ntomas 41&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;0 a&#241;os&#46; El 81&#44;9&#37; fue de sexo femenino&#46; La media de DAS-28 fue 3&#44;46&#46; El 12&#44;9&#37; de pacientes era fumador&#46; La osteoporosis &#40;32&#44;3&#37; de pacientes&#41; e hipertensi&#243;n arterial &#40;32&#44;1&#37;&#41; fueron las comorbilidades m&#225;s frecuentes y metotrexate &#40;98&#46;4&#37;&#41; el medicamento m&#225;s prescrito&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Es el primer estudio en Colombia que utiliza una cohorte amplia y aporta informaci&#243;n v&#225;lida que establece las caracter&#237;sticas cl&#237;nicas&#44; comportamiento de la enfermedad&#44; comorbilidades y tendencias de la medicaci&#243;n en el pa&#237;s&#46;</p></span>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Frequency &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1364&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleItalic">Age &#40;mean</span><span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SD&#41;&#44; years</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">53&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleItalic">Gender &#40;female</span>&#47;<span class="elsevierStyleItalic">male&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">1111&#47;246&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">81&#46;9&#47;18&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleItalic">Education level of 411 records &#40;basic primary</span>&#47;<span class="elsevierStyleItalic">secondary</span>&#47;<span class="elsevierStyleItalic">university&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">242&#47;96&#47;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">58&#46;9&#47;23&#46;4&#47;17&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleItalic">Alcohol consumption &#40;1030 records&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">2&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleItalic">Smoking &#40;1045 records&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">135&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">12&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="bottom"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="bottom"><span class="elsevierStyleItalic">Diagnosis</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleHsp" style=""></span>Seropositive RA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">781&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">57&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleHsp" style=""></span>RA&#44; unspecified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">400&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">29&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleHsp" style=""></span>Seronegative RA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">126&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">9&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleHsp" style=""></span>Juvenile RA and Juvenile&#44; Unspecified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">1&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleHsp" style=""></span>Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleHsp" style=""></span>Arthritis&#44; unspecified&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleHsp" style=""></span>Without diagnosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="bottom"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="bottom"><span class="elsevierStyleItalic">Clinical</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleHsp" style=""></span>Age at onset &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&#44; years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">41&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleHsp" style=""></span>Age at diagnosis &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&#44; years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">43&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleHsp" style=""></span>Disease progress &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&#44; months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">116&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>91&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="bottom"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="bottom"><span class="elsevierStyleItalic">Disease-modifying antirheumatic drug</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleHsp" style=""></span>Methotrexate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">1343&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">98&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleHsp" style=""></span>Prednisolone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">1246&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">91&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleHsp" style=""></span>Leflunomide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">979&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">71&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleHsp" style=""></span>Chloroquine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">657&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">48&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleHsp" style=""></span>Sulfasalazine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">515&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">37&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleHsp" style=""></span>Deflazacort&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">288&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">21&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleHsp" style=""></span>Etanercept&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">133&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">9&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleHsp" style=""></span>Hydroxychloroquine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">113&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">8&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleHsp" style=""></span>Abatacept&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">5&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleHsp" style=""></span>Methylprednisolone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">5&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleHsp" style=""></span>Adalimumab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">4&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleHsp" style=""></span>Infliximab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">4&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="bottom"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="bottom"><span class="elsevierStyleItalic">Comorbidities</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleHsp" style=""></span>Osteoporosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">440&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">32&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleHsp" style=""></span>High blood pressure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">438&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">32&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleHsp" style=""></span>Dyslipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">327&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">24&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleHsp" style=""></span>Other autoimmune diseases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">139&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">10&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">6&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleHsp" style=""></span>Chronic Obstructive Pulmonary Disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">4&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="bottom"><span class="elsevierStyleHsp" style=""></span>Congestive Heart Failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="bottom">1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                    0 => array:2 [
                      "titulo" => "2010 Rheumatoid arthritis classification criteria&#58; an American College of Rheumatology&#47;European League Against Rheumatism collaborative initiative"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Aletaha"
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                      "titulo" => "The pathogenesis of rheumatoid arthritis"
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                            0 => "I&#46;B&#46; McInnes"
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                    0 => array:2 [
                      "doi" => "10.1056/NEJMra1004965"
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                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2011"
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                        "paginaInicial" => "2205"
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                            0 => "A&#46;M&#46; Wasserman"
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                        "tituloSerie" => "Am Fam Phys"
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                      "titulo" => "My treatment approach to rheumatoid arthritis"
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                            0 => "J&#46;M&#46; Davis"
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Article information

ISSN: 01218123
Original language: English

DOI:10.1016/j.rcreu.2015.05.006

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 October	26	6	32
2024 September	38	24	62
2024 August	33	15	48
2024 July	26	7	33
2024 June	17	4	21
2024 May	26	4	30
2024 April	33	5	38
2024 March	20	6	26
2024 February	17	3	20
2024 January	30	5	35
2023 December	28	5	33
2023 November	36	6	42
2023 October	30	9	39
2023 September	21	5	26
2023 August	16	1	17
2023 July	24	6	30
2023 June	21	3	24
2023 May	44	4	48
2023 April	32	1	33
2023 March	23	1	24
2023 February	34	6	40
2023 January	35	8	43
2022 December	34	5	39
2022 November	47	7	54
2022 October	17	6	23
2022 September	20	8	28
2022 August	15	8	23
2022 July	18	6	24
2022 June	12	9	21
2022 May	32	10	42
2022 April	26	10	36
2022 March	28	8	36
2022 February	16	9	25
2022 January	33	12	45
2021 December	14	12	26
2021 November	15	9	24
2021 October	27	14	41
2021 September	14	8	22
2021 August	23	4	27
2021 July	18	9	27
2021 June	28	16	44
2021 May	38	6	44
2021 April	43	13	56
2021 March	20	4	24
2021 February	15	6	21
2021 January	28	7	35
2020 December	29	21	50
2020 November	27	14	41
2020 October	18	5	23
2020 September	11	5	16
2020 August	14	16	30
2020 July	30	8	38
2020 June	8	14	22
2020 May	13	12	25
2020 April	19	10	29
2020 March	18	2	20
2020 February	18	10	28
2020 January	18	16	34
2019 December	18	8	26
2019 November	18	7	25
2019 October	34	6	40
2019 September	34	6	40
2019 August	18	6	24
2019 July	15	17	32
2019 June	74	24	98
2019 May	161	26	187
2019 April	72	9	81
2019 March	17	13	30
2019 February	16	10	26
2019 January	23	5	28
2018 December	22	10	32
2018 November	12	11	23
2018 October	37	6	43
2018 September	18	7	25
2018 August	5	8	13
2018 July	12	8	20
2018 June	8	8	16
2018 May	13	15	28
2018 April	9	7	16
2018 March	9	8	17
2018 February	13	4	17
2018 January	16	5	21
2017 December	24	3	27
2017 November	23	9	32
2017 October	28	12	40
2017 September	20	10	30
2017 August	12	11	23
2017 July	20	26	46
2017 June	15	18	33
2017 May	26	14	40
2017 April	21	8	29
2017 March	34	16	50
2017 February	31	8	39
2017 January	35	11	46
2016 December	35	14	49
2016 November	31	19	50
2016 October	44	24	68
2016 September	55	9	64
2016 August	42	24	66
2016 July	53	10	63
2016 June	51	34	85
2016 May	44	50	94
2016 April	47	56	103
2016 March	67	67	134
2016 February	51	68	119
2016 January	64	52	116
2015 December	57	39	96
2015 November	38	31	69
2015 October	28	20	48

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