A community-based study on the prevalence of spondyloarthritis and inflammatory back pain in Mexicans.

BACKGROUND: The prevalence of spondyloarthritis (SpA) varies across populations. In Mexicans, the prevalence of SpA is still unknown. OBJECTIVE: The objective of this study was to determine the prevalence of SpA in the community as well as that of inflammatory back pain (IBP) and ankylosing spondylitis (AS). METHODS: We identified individuals older than 18 years with nontraumatic back pain (BP) in a door-to-door nurse survey using the Community Oriented Program for the Control of Rheumatic Diseases. Then, general physicians and rheumatology fellows selected those likely to have IBP (Berlin criteria). Finally, 2 expert rheumatologists assessed IBP individuals according to clinical data and classification criteria and requested HLA-B27 and radiographic studies to determine the clinical condition of the individual and SpA (European SpA Study Group) classification. RESULTS: The prevalence of BP among 4059 individuals was 14.6% (95% confidence interval [CI], 13.6-15.8). The prevalence of IBP and SpA was 1.3% (95% CI, 1.0-1.7) and 0.6% (95% CI, 0.4-0.9), respectively. Ankylosing spondylitis prevalence was 0.1% (95% CI, 0.02-0.2). Inflammatory back pain and SpA percentage of males and females was similar. The percentage of individuals with IBP according to the 2 experts was lower than that determined by general physicians and rheumatology fellows, but all cases with HLA-B27, radiographic sacroiliitis, SpA, and AS had previous IBP confirmation by the expert. CONCLUSIONS: The prevalence and sex distribution of patients classified with SpA in this community study--as well as that of patients diagnosed with AS--are consistent with those found in recent studies. Expert assessment of individuals with positive responses to questionnaires is relevant for the classification of IBP and SpA.

The use of glucocorticoids by rheumatologic patients before attending a specialized department in México.

OBJECTIVE: To explore the extent and characteristics of glucocorticoid use by patients before attending a Mexican Rheumatology Department. MATERIAL AND METHODS: This is a cross-sectional study of 1000 consecutive first-time adults admitted to the outpatient clinic in a period of 6 months. Data were collected through a self-administered questionnaire, physician interviews, and prescription notes. RESULTS: Four hundred and sixty-one (58%) of 800 questionnaires analyzed reported glucocorticoid use: 73% of them were continuous users; 63% received long and 36% medium biologic half life compounds; and each patient received a median of 2 glucocorticoids (range, 1-42). The median daily, maximum, and cumulated doses--equivalent to prednisone--were 5 mg (0.7-70 mg), 6 mg (1.1-1250 mg), and 513 mg (5-151,209 mg); 46% of the patients received oral and 22% intramuscular compounds. General physicians and nonrheumatologist specialists produced 55% and 20% of the initial prescriptions. Although, the percentage of glucocorticoid users was higher among patients with inflammatory conditions (odds ratio 4.2, 95% confidence intervals 3.06-5.85), up to 44% of patients with noninflammatory diseases also received glucocorticoids. Ninety-one (20%) patients had gross adverse events. CONCLUSIONS: Before their first visit to a specialized department, nearly two-thirds of rheumatologic patients had taken glucocorticoids, which in most cases resulted from inappropriate prescription or recommendations by general physicians, nonrheumatologist specialists, and lay people.