Catastrophic health expenses and impoverishment of households of patients with rheumatoid arthritis.

BACKGROUND: The cost of certain diseases may lead to catastrophic expenses and impoverishment of households without full financial support by the state and other organizations. OBJECTIVE: To determine the socioeconomic impact of the rheumatoid arthritis (RA) cost in the context of catastrophic expenses and impoverishment. PATIENTS AND METHODS: This is a cohort-nested cross-sectional multicenter study on the cost of RA in Mexican households with partial, full, or private health care coverage. Catastrophic expenses referred to health expenses totaling >30% of the total household income. Impoverishment defined those households that could not afford the Mexican basic food basket (BFB). RESULTS: We included 262 patients with a mean monthly household income (US dollars) of $376 (0­18,890.63). In all, 50.8%, 35.5%, and 13.7% of the patients had partial, full, or private health care coverage, respectively. RA annual cost was $ 5534.8 per patient (65% direct cost, 35% indirect). RA cost caused catastrophic expenses in 46.9% of households, which in the logistic regression analysis were significantly associated with the type of health care coverage (OR 2.7, 95%CI 1.6­4.7) and disease duration (OR 1.024, 95%CI 1.002­1.046). Impoverishment occurred in 66.8% of households and was associated with catastrophic expenses (OR 3.6, 95%CI 1.04­14.1), high health assessment questionnaire scores (OR 4.84 95%CI 1.01­23.3), and low socioeconomic level (OR 4.66, 95%CI 1.37­15.87). CONCLUSION: The cost of RA in Mexican households, particularly those lacking full health coverage leads to catastrophic expenses and impoverishment. These findings could be the same in countries with fragmented health care systems.

Comparison of clinical features and drug therapies among European and Latin American patients with juvenile dermatomyositis.

OBJECTIVES: To compare the demographic features, presenting manifestations, diagnostic investigations, disease course, and drug therapies of children with juvenile dermatomyositis (JDM) followed in Europe and Latin America. METHODS: Patients were inception cohorts seen between 1980 and 2004 in 27 paediatric rheumatology centres. The following information was collected through the review of patient charts: sex; age at disease onset; date of disease onset and diagnosis; onset type; presenting clinical features; diagnostic investigations; course type; and medications received during disease course. RESULTS: Four hundred and ninety patients (65.5% females, mean onset age 7.0 years, mean disease duration 7.7 years) were included. Disease presentation was acute or insidious in 57.1% and 42.9% of the patients, respectively. The course type was monophasic in 41.3% of patients and chronic polycyclic or continuous in 58.6% of patients. The more common presenting manifestations were muscle weakness (84.9%), Gottron's papules (72.9%), heliotrope rash (62%), and malar rash (56.7%). Overall, the demographic and clinical features of the 2 continental cohorts were comparable. European patients received more frequently high-dose intravenous methylprednisolone, cyclosporine, cyclophosphamide, and azathioprine, while methotrexate and antimalarials medications were used more commonly by Latin American physicians. CONCLUSIONS: The demographic and clinical characteristics of JDM are similar in European and Latin American patients. We found, however, several differences in the use of medications between European and Latin American paediatric rheumatologists.

Frecuencia de uso de medicinas complementarias y alternativas en sujetos que acuden por primera vez al servicio de reumatología. Análisis de 800 casos / Complementary and alternative medicine in patients attending a rheumatology department for the first time. Analysis of 800 patients

Objetivos: Determinar la frecuencia del uso de terapias complementarias y alternativas (TCA) en pacientes que acuden por primera vez a un servicio de reumatología. Sujetos y métodos: Se incluyeron consecutivamente a pacientes que acudieron por primera vez a una consulta de reumatología. Todos los pacientes llenaron un cuestionario autoadministrado en el cual se recababan datos demográficos y el diagnóstico previo, además marcaron en una lista de 22 diferentes TCA las que habían utilizado. Resultados: Se estudiaron 800 pacientes. El 80% eran mujeres, con edad de 44,78 ± 14,9 años y escolaridad de 7,12 ± 3,97 años. Los principales diagnósticos fueron osteoartritis (29,4%), artritis reumatoide (22,3%) y fibromialgia (6,5%). El 71,1% utilizaron TCA, con una mediana de 2 (0-14) tipos diferentes. Las más comunes fueron complementos vitamínicos (38%), árnica (18%), sábila (15%) y homeopatía (15%). No se encontraron diferencias significativas en relación con el sexo, la edad, la escolaridad ni el diagnóstico. El uso de TCA fue más frecuente en pacientes con mayor tiempo de evolución de la enfermedad. Conclusiones. La prevalencia de uso de TCA es alta en pacientes con manifestaciones reumatológicas.(AU)

Objectives: To determine the frequency of the use of complementary and alternative medicine (CAM) in patients attending a rheumatology department in a general hospital for the first time. Subjects and methods: We included consecutive patients attending our rheumatology department for the first time. All the patients completed a self-administered questionnaire containing items on demographic data, and prior diagnosis. The patients were also given a list of 22 different CAM and marked those they had previously used. Results: Eight hundred patients were studied. Eighty percent were women. The mean age was 44.8 ± 14.9 years and the mean number of years of education was 7 ± 4. The main diagnoses were osteoarthritis (29.4%), rheumatoid arthritis (22.3%), and fibromyalgia (6.5%). Seventy-one percent had previously used CAM, with a median of two (0-14) different types. The most common were vitamin supplements (38%), arnica (18%), Aloe vera (15%) and homeopathy (15%). No significant differences were found in sex, age, educational level, or diagnosis. The use of CAM was more frequent in patients with longer disease duration. Conclusions: The frequency of use of CAM is high in patient with rheumatologic manifestations(AU)

[Complementary and alternative medicine in patients attending a rheumatology department for the first time. Analysis of 800 patients]. / Frecuencia de uso de medicinas complementarias y alternativas en sujetos que acuden por primera vez al servicio de reumatología. Análisis de 800 casos.

OBJECTIVES: To determine the frequency of the use of complementary and alternative medicine (CAM) in patients attending a rheumatology department in a general hospital for the first time. SUBJECTS AND METHODS: We included consecutive patients attending our rheumatology department for the first time. All the patients completed a self-administered questionnaire containing items on demographic data, and prior diagnosis. The patients were also given a list of 22 different CAM and marked those they had previously used. RESULTS: Eight hundred patients were studied. Eighty percent were women. The mean age was 44.8±14.9 years and the mean number of years of education was 7±4. The main diagnoses were osteoarthritis (29.4%), rheumatoid arthritis (22.3%), and fibromyalgia (6.5%). Seventy-one percent had previously used CAM, with a median of two (0-14) different types. The most common were vitamin supplements (38%), arnica (18%), Aloe vera (15%) and homeopathy (15%). No significant differences were found in sex, age, educational level, or diagnosis. The use of CAM was more frequent in patients with longer disease duration. CONCLUSIONS: The frequency of use of CAM is high in patient with rheumatologic manifestations.