RESUMO
Introducción: las necesidades y perspectivas de los pacientes son determinantes para tratar la artritis reumatoidea (AR). Objetivos: evaluar el impacto de la respuesta inadecuada a los fármacos antirreumáticos modificadores de la enfermedad (DMARD) sobre la satisfacción con el tratamiento, los resultados y las perspectivas de pacientes adultos con control inadecuado de la AR de actividad moderada/alta. Materiales y métodos: se evaluó la satisfacción mediante el cuestionario Treatment Satisfaction Questionnaire for Medication (TSQM) v1.4. Se recolectaron datos sobre la calidad de vida, la adherencia y las estrategias de manejo. Se presentan los resultados para Argentina, Chile y Uruguay (n=202). Resultados: el promedio de la escala de satisfacción global TSQM fue de 62,3±21,8. El 83% informó buena adherencia. Las principales expectativas del tratamiento fueron "alivio duradero de los síntomas" y "menos dolor articular". El 53,47% prefirió tratamiento oral y el 75,74% eligió un rápido inicio de acción. El efecto secundario menos aceptado fue "mayor riesgo de neoplasias". Se planificó rotar el DMARD en el 55% de los casos. De estos, el 84,7% se consideraron terapias avanzadas. La mayoría estaba abierto a un esquema combinado, pero el 25,2% prefirió no utilizarlo. Conclusiones: los resultados reafirman el compromiso con las estrategias treat-to-target, considerando la individualización de las decisiones terapéuticas en el contexto regional.
Introduction: patients' needs and perspectives are determinants for the treatment of rheumatoid arthritis (RA). Objectives: to evaluate the impact of inadequate response to disease-modifying antirheumatic drugs (DMARDs) on treatment satisfaction, outcomes and perspectives of adult patients with inadequate control of moderate/high activity RA. Materials and methods: satisfaction was assessed using the TSQM v1.4 questionnaire. Data on quality of life, adherence and management strategies were collected. Results are presented for Argentina, Chile and Uruguay (n=202). Results: the mean of the TSQM global satisfaction score was 62.3±21.8. Eighty-three percent reported good adherence. The main expectations of treatment were "lasting relief of symptoms" and "less joint pain". The 53.47% of patients preferred an oral treatment; 75.74% chose a rapid onset of action. The least accepted side effect was "increased risk of malignant neoplasms". Fifty-five percent planned to rotate DMARD. Of these, advanced therapies were considered in only 84.7%. Most were open to a combination treatment, but 25.2% preferred not to use it. Conclusions: the results reaffirm the commitment to treat-to-target strategies, considering the individualization of therapeutic decisions in the regional context.
RESUMO
Patients with rheumatic autoimmune diseases have a higher risk of infections compared with age-and sex-matched controls. In Latin America, there are no validated tools to assess the risk of serious infection. The objectives were to estimate the incidence of serious infections in a cohort of rheumatoid arthritis (RA) patients followed for 12 months and to validate the RABBIT risk score for serious infections. Patients with RA were included and followed for 12 months. Baseline sociodemographic data, comorbidities, RA characteristics, and vaccination status were recorded. The baseline RABBIT risk score was calculated. Serious infections were documented, describing site and time since enrollment. Six hundred five patients were included (13 centers). The incidence of serious infection was 5% (95% CI 3-7). The most frequent sites were respiratory and urinary (90%). Performance of RABBIT risk score: patients with no infection during follow-up had a median score of 1.2 (IQR 0.8-2.1) and patients with infection 5.1 (IQR 2.15-12.6) p 0.00001. ROC curve analysis: AUC 0.86 (95% CI 0.8-0.94), best cut-off 2.85 (sensibility 75%, specificity 85%). The incidence of serious infections was 5% during the follow-up. The RABBIT score performed excellently in our patients. Key Points ⢠The RABBIT risk score for serious infections showed an excellent performance in a population different (Latin America) from the original one included in the German registry. ⢠This may assist rheumatologists in selecting drugs for patients according to the individual risk of infection, in a fast and simple way.
