RESUMEN
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.
Asunto(s)
Dolor de Espalda/epidemiología , Espondiloartritis/epidemiología , Adulto , Dolor de Espalda/etiología , Dolor de Espalda/inmunología , Femenino , Antígeno HLA-B27/sangre , Encuestas Epidemiológicas , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Prevalencia , Características de la Residencia , Espondiloartritis/complicaciones , Espondiloartritis/inmunología , Espondilitis Anquilosante/complicaciones , Espondilitis Anquilosante/epidemiología , Espondilitis Anquilosante/inmunología , Encuestas y CuestionariosRESUMEN
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.