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IMPLANTATION OF AN OUTPATIENT RHEUMATOID ARTHRITIS CLINIC IN A SECONDARY HEALTH CARE FACILITY IN THE SECOND MOST POPULOUS CITY OF PERNAMBUCO AND CLINICAL/EPIDEMIOLOGICAL PROFILE OF THE ASSISTED PATIENTS: A SIX-MONTHS EXPERIENCE
Rheumatoid arthritis (RA) is a chronic disease characterized by multiple joint involvement and morbidity. In Brazil, it is estimated that 1% of adult population from macroregions has the disease. Jaboatão dos Guararapes is the second most populous city in the state of Pernambuco and there are no public services within the city to assist specifically patients with RA. The objective of this study is to report the implementation of an outpatient rheumatoid arthritis clinic in a secondary health care facility. Also, we aimed to describe the epidemiological profile of patients diagnosed with RA.
Materials and methods
This work was developed in one of the six secondary health care facilities of Jaboatão dos Guararapes between December 2018 and June 2019. The project of implantation of a specialized outpatient clinic for patients with RA was presented to the managers and patients were referred by the rheumatologist of the institution during regular care and general physicians for the evaluation of the diagnosis by the specialist. The management team was trained about the importance of health care of RA. The epidemiological and clinical profile of the patients was done by medical records review.
Fifty-five patients with clinical diagnosis of RA established by the Rheumatologist were assisted. Mean age was 61.3 years (+ 12.6) , 90.9% were female and only seven patients (12.7%) had previous diagnosis of RA. The time of onset of joint symptoms was defined by 45.4% of patients (mean of 61.24 months). Regarding associated comorbidities, 60% (33 patients) had hypertension, 30.9% (17 patients) had diabetes. Therapy of patients are summarized in table 1. Fourteen out 17 diabetic patients (82.4%) had associated hypertension (82.4%) vs. 19 out of 38 (50%) with no hypertension, p=0.036. Patients with no hypertension were under higher median doses of prednisone (or equivalent) than patients with hypertension (10 [IQR:7.5 – 10] vs. 7.5 [IQR: 5- 7.5]; p=0.0253). Regarding diabetic patients, 3 out of 28 (10.7%) were under corticosteroid therapy vs. 14 out of 27 (51.9%) that were not, p=0.001.
The estimated population of Jaboatão dos Guararapes is 697,636 inhabitants. Considering the high prevalence of RA, the implementation of a specific rheumatoid arthritis outpatient clinic may offer prompt diagnosis and treatment, which may lead to reduction in associated morbidity and mortality. A future agenda must include awareness of staff and population of the importance of rheumatoid arthritis as well as educational and multidisciplinary activities in order to increase the number of assisted patients.
Health Care Economics and Organization
Hugo Deleon Lima, Renan Mesel Correia, Liziana Gorete Oliveira Luna, Márcia Cecília Melo Ramos, Leonardo Gonçalves Pereira Lima, Marcela Elias Araújo, Lilianne Erica Amorim Rocha, Mirella Patrício Rodrigues, Laurindo Ferreira Rocha Jr