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2.
Reumatol Clin (Engl Ed) ; 17(9): 491-493, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34756308

RESUMO

SARS-COV-2 infection has spread worldwide since it originated in December 2019, in Wuhan, China. The pandemic has largely demonstrated the resilience of the world's health systems and is the greatest health emergency since World War II. There is no single therapeutic approach to the treatment of COVID-19 and the associated immune disorder. The lack of randomised clinical trials (RCTs) has led different countries to tackle the disease based on case series, or from results of observational studies with off-label drugs. We as rheumatologists in general, and specifically rheumatology fellows, have been on the front line of the pandemic, modifying our activities and altering our training itinerary. We have attended patients, we have learned about the management of the disease and from our previous experience with drugs for arthritis and giant cell arteritis, we have used these drugs to treat COVID-19.


Assuntos
Antivirais/uso terapêutico , Fatores Biológicos/uso terapêutico , COVID-19/tratamento farmacológico , Imunossupressores/uso terapêutico , Papel do Médico , Reumatologistas , Doenças Autoimunes/complicações , Doenças Autoimunes/tratamento farmacológico , Doenças Autoimunes/imunologia , COVID-19/complicações , COVID-19/epidemiologia , COVID-19/imunologia , Quimioterapia Combinada , Educação de Pós-Graduação em Medicina , Bolsas de Estudo , Saúde Global , Humanos , Hospedeiro Imunocomprometido , Infecções Oportunistas/complicações , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/imunologia , Equipe de Assistência ao Paciente/organização & administração , Padrões de Prática Médica , Doenças Reumáticas/complicações , Doenças Reumáticas/tratamento farmacológico , Doenças Reumáticas/imunologia , Reumatologistas/educação , Reumatologistas/organização & administração , Reumatologia/educação , Reumatologia/métodos , Reumatologia/organização & administração , Espanha/epidemiologia
4.
Z Rheumatol ; 80(9): 801-818, 2021 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-34709435

RESUMO

Rheumatologic practices were still rare in the early 1990s and rheumatologic treatment took place mainly in the rheumatology clinics and university rheumatology clinics. In the following decades, the number of the rheumatologists in private practices increased and in the year 2004 about two thirds of the outpatient care were already carried out in private practices. In 2020 a total of 597 rheumatologists out of 1106 nationwide worked in private practices, including 203 who were employed. Since 2008, the number of rheumatologists in medical care centers increased more than the number of rheumatologists in private practice. In 2020 only 75% of panel rheumatologists in private practice were in full-time employment. This development to an altered work mentality of the incoming generation and an age structure in which approximately 30% of panel rheumatologists are older than 60 years, threatens a further deterioration of the anyway insufficient outpatient care. In contrast, there are developments that strengthen the outpatient care especially in practices, such as the outpatient specialist medical care and quality-oriented selective contracts as well as rheumatological and immunological laboratory diagnostics. These cornerstones give rheumatology a special position in the panel medical care within the group of specialties in internal medicine and an attractive economic basis. In addition to the medically and scientifically interesting discipline, this could be a further incentive for young trainees to choose rheumatology as a specialty and working in a private practice.


Assuntos
Reumatologia , Assistência Ambulatorial , Humanos , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Prática Privada , Reumatologistas
5.
Z Rheumatol ; 80(9): 846-854, 2021 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-34605978

RESUMO

BACKGROUND: In recent years outpatient rheumatology has developed into one of the most important pillars of rheumatological care. The better diagnostic possibilities, the well-founded training of rheumatologists and the diverse guidelines have led to increasingly more patients being diagnosed as outpatients and can be treated by the most modern options as outpatients. Nevertheless, limits have also been set for outpatient rheumatology. OBJECTIVE: This article aims to highlight what the limits of outpatient rheumatology currently are and who sets the limits. The presentation of the limitations should help all participants in the healthcare system to avoid false expectations and frustration; however, limits can also be relocated or overcome by appropriate motivation. The long-term target should be a further improvement in the interaction between outpatient and inpatient rheumatology and therefore the rheumatological care of patients. RESULTS AND DISCUSSION: The medical limits of outpatient rheumatology are relatively clear and predominantly uncontroversial, the unjustified referral to the inpatient section is, for example, relatively rarely a problem. Some theoretically possible outpatient interventions are carried out in the inpatient sector more due to logistical problems. The healthcare political and legal limitations of outpatient rheumatological institutions are greater. Despite further limitations of outpatient rheumatology this discipline and the outpatient activity still represents an exciting, modern and last but not least a very satisfying activity, which is promoted here.


Assuntos
Doenças Reumáticas , Reumatologia , Assistência Ambulatorial , Humanos , Pacientes Ambulatoriais , Doenças Reumáticas/diagnóstico , Doenças Reumáticas/terapia , Reumatologistas
6.
Z Rheumatol ; 80(9): 827-834, 2021 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-34618210

RESUMO

Data analyses in rheumatology practices can be used as a feedback system in quality management. Implementation of a representative patient survey enables evaluation of one's own work and can be used for external presentation of the practice. Patient education and the structured use of specialist rheumatology assistants were evaluated by means of a survey. Systematic screening for depressive symptoms was carried out and enables a better understanding of patients and their "unmet needs". An analysis of the diseases and the patients in terms of physical function, disease activity, medication, and concomitant diseases is possible using structured patient documentation in a specialized documentation system. Within the RHADAR network (RheumaDatenRhePort G.b.R.), the proportion of rheumatoid arthritis patients treated with Janus kinase inhibitors was compared between different centers. Patients suitable for clinical trials can be filtered out of a structured documentation system.


Assuntos
Artrite Reumatoide , Reumatologia , Análise de Dados , Humanos , Inquéritos e Questionários
7.
Z Rheumatol ; 80(9): 795-800, 2021 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-34618211

RESUMO

The corona pandemic changed the lives of people in Germany in 2020. Completely new challenges had to be met in outpatient care and of course also in rheumatology practices. The rapid development, the constant changes, the readjustment, the accompaniment of patients and staff team in this global catastrophe are described. The influence on the daily work and the implementation of new scientific knowledge, e.g. the recommendations of the German Society of Rheumatology (DGRh), are reported. Experiences and insights into what can be learned and taken away from crisis situations are outlined. A detailed chronology of the events, taking the special rheumatological features into account, completes this report of experiences.


Assuntos
Doenças Reumáticas , Reumatologia , Assistência Ambulatorial , Alemanha , Humanos , Pandemias , Doenças Reumáticas/diagnóstico , Doenças Reumáticas/epidemiologia
8.
Arthritis Res Ther ; 23(1): 252, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34598717

RESUMO

BACKGROUND: The occurrence of health events preceding a psoriatic arthritis (PsA) diagnosis may serve as predictors of diagnosis. We sought to assess patients' real-world experiences in obtaining a PsA diagnosis. METHODS: This retrospective cohort study analyzed MarketScan claims data from January 2006 to April 2019. Included were adult patients with ≥ 2 PsA diagnoses (ICD-9-CM/ICD-10-CM) ≥ 30 days apart with ≥ 6 years of continuous enrolment before PsA diagnosis. Controls were matched 2:1 to patients with PsA. Health events (diagnoses and provider types) were analyzed before PsA diagnosis and additionally stratified by presence of psoriasis. RESULTS: Of 13,661 patients, those with PsA had an increased history of coding for arthritis and dermatologic issues (osteoarthritis [48% vs 22%], rheumatoid arthritis [18% vs 2%], and psoriasis [61% vs 2%]) vs those without PsA. Diagnoses of arthritis, axial symptoms, and tendonitis/enthesitis increased over time preceding PsA diagnosis; notably, a sharp rise in psoriasis diagnoses was observed 6 months before PsA diagnosis. Rheumatology consults were more common immediately preceding a PsA diagnosis. Dermatologists were unlikely to code for arthritis and musculoskeletal issues, while rheumatologists were unlikely to code for psoriasis; general practitioners focused on axial and musculoskeletal symptoms. PsA was most commonly diagnosed by rheumatologists (40%), general practitioners (22%), and dermatologists (7%). CONCLUSIONS: Rheumatologists, general practitioners, and dermatologists diagnosed two thirds of patients with PsA. Musculoskeletal symptoms were common preceding a PsA diagnosis. Greater awareness of patterns of health events may alert healthcare providers to suspect a diagnosis of PsA.


Assuntos
Artrite Psoriásica , Psoríase , Reumatologia , Adulto , Artrite Psoriásica/diagnóstico , Artrite Psoriásica/epidemiologia , Humanos , Estudos Retrospectivos , Reumatologistas
9.
Reumatol Clin (Engl Ed) ; 17(8): 431-436, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34625144

RESUMO

The novel SARS-CoV-2 human coronavirus in Wuhan, China, has triggered a worldwide respiratory disease outbreak (COVID-19). Acute respiratory distress syndrome (ARDS), multiorgan dysfunction and thrombotic events are among the leading causes of death in critically ill patients with COVID-19. The elevated inflammatory cytokines suggest that a "cytokine storm", also known as cytokine release syndrome (CRS), may play a major role in the pathology of COVID-19. In addition to anti-viral therapy and supportive treatment in critically ill patients, unique medications for this condition are also under investigation. Here we reviewed therapeutic options, including the antibody therapy that might be an immediate strategy for SARS-CoV-2 therapy.


Assuntos
COVID-19/terapia , Síndrome da Liberação de Citocina/terapia , Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Antivirais/uso terapêutico , COVID-19/complicações , COVID-19/diagnóstico , COVID-19/imunologia , Cloroquina/uso terapêutico , Terapia Combinada , Síndrome da Liberação de Citocina/diagnóstico , Síndrome da Liberação de Citocina/imunologia , Síndrome da Liberação de Citocina/virologia , Fibrinolíticos/uso terapêutico , Glucocorticoides/uso terapêutico , Humanos , Hidroxicloroquina/uso terapêutico , Imunização Passiva , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Troca Plasmática , Inibidores de Proteínas Quinases/uso terapêutico , Terapia Respiratória , Reumatologia , Índice de Gravidade de Doença , Trombose/tratamento farmacológico , Trombose/virologia
10.
Rev Med Liege ; 76(10): 741-745, 2021 Oct.
Artigo em Francês | MEDLINE | ID: mdl-34632743

RESUMO

We realized an observational retrospective study about pediatric patients (between 1 to 18 years) followed at the CHU Liège in an adult rheumatologic service during the last 14 years. This study identified 102 patients who developed the first symptoms during infancy, identifying 39 different diseases. Mainly, we identify cases of idiopathic juvenile arthritis, rheumatoid arthritis, spondylarthropathies, systemic lupus erythematosus, systemic vasculitis, connective tissue diseases, bone diseases, and phosphocalcic metabolic disorders. These observations highlight the difficulties to classify inflammatory articular diseases in young patients. Furthermore, this article may be helpful to identify some specificities in the pediatric population who suffers from rheumatologic diseases and some essential factors to make an optimal transition to adult medicine.


Assuntos
Artrite Juvenil , Artrite Reumatoide , Lúpus Eritematoso Sistêmico , Reumatologia , Adulto , Artrite Juvenil/diagnóstico , Artrite Juvenil/epidemiologia , Artrite Juvenil/terapia , Criança , Humanos , Estudos Retrospectivos
11.
BMC Health Serv Res ; 21(1): 1124, 2021 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-34666756

RESUMO

BACKGROUND: Reducing inappropriate referrals to specialists is a challenge for the healthcare system as it seeks to transition from volume to value-based healthcare. Given the projection of a severe shortage of rheumatologists in the near future, innovative strategies to decrease demand for rheumatology services may prove more fruitful than increasing the supply of rheumatologists. Efforts to increase appropriate utilization through reductions in capacity may have the unintended consequence of reducing appropriate care as well. This highlights the challenges in increasing the appropriate use of high cost services as the health system transitions to value based care. The objective of this study was to analyze factors affecting appropriateness of rheumatology services. METHODS: This was a cross-sectional study of patients receiving Rheumatology services between November 2013 and October 2019. We used a proxy for "appropriateness": whether or not there was any follow-up care after the first appointment. Results from regression analysis and physicians' chart reviews were compared using an inter-rater reliability measure (kappa). Data was drawn from the EHR 2013-2019. RESULTS: We found that inappropriate referrals increased 14.3% when a new rheumatologist was hired, which increased to 14.8% after wash-out period of 6 months; 15.7% after 12 months; 15.5% after 18 months and 16.7% after 18 months. Other factors influencing appropriateness of referrals included severity of disease, gender and insurance type, but not specialty of referring provider. CONCLUSIONS: Given the projection of a severe shortage of rheumatologists in the near future, innovative strategies to decrease demand for rheumatology services may prove more fruitful than increasing the supply of rheumatologists. Innovative strategies to decrease demand for rheumatology services may prove more fruitful than increasing the supply of rheumatologists. These findings may apply to other specialties as well. This study is relevant for health care systems that are implementing value-based payment models aimed at reducing inappropriate care.


Assuntos
Reumatologia , Estudos Transversais , Humanos , Encaminhamento e Consulta , Reprodutibilidade dos Testes , Reumatologistas
12.
Br J Nurs ; 30(18): 1056-1064, 2021 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-34645352

RESUMO

BACKGROUND: Patient demand for education and access to the clinical nurse specialists (CNSs) during the rheumatology clinic at one hospital in Ireland was increasing. Alternative methods of providing patient education had to be examined. AIMS: To explore the efficacy of video-based outpatient education, and its impact on demand for the CNSs. METHODS: A video was produced to play in a rheumatology outpatient department. A representative sample of 240 patients (120 non-exposed and 120 exposed to the video) attending the clinic was selected to complete a questionnaire exploring the effect of the video. Data were analysed using chi-square tests with Yates' continuity correction. FINDINGS: Demand for the CNSs was six times higher in the non-exposed group compared with the exposed group (non-exposed: 25%, exposed: 4.8%) (χ2=15.7, P=0.00007), representing a significant decrease in resource demand. CONCLUSION: High-quality educational videos on view in the rheumatology outpatient department provide patients with information sufficient to meet their educational needs, thus releasing CNS resources.


Assuntos
Enfermeiras Clínicas , Reumatologia , Instituições de Assistência Ambulatorial , Humanos , Pacientes Ambulatoriais , Inquéritos e Questionários
13.
Zhonghua Nei Ke Za Zhi ; 60(11): 946-953, 2021 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-34689514

RESUMO

Rheumatic diseases are a kind of chronic inflammatory diseases mainly involving joints and surrounding tissues. Most patients with rheumatic diseases need long-term treatment, which is difficult to be avoided during pregnancy. Treatment efficacy, as well as maternal and fetal safety should be taken into account in the medical decision. Based on the domestic and foreign guidelines, consensus, diagnosis and treatment experience, Chinese Rheumatology Association developed the standardization of medication use in patients with rheumatic diseases preparing and during pregnancy, aiming on the application and precautions of commonly used medicines for rheumatic diseases in preparing pregnancy, pregnancy and lactation.


Assuntos
Doenças Reumáticas , Reumatologia , Consenso , Feminino , Humanos , Gravidez , Doenças Reumáticas/tratamento farmacológico
14.
Arthritis Res Ther ; 23(1): 254, 2021 10 09.
Artigo em Inglês | MEDLINE | ID: mdl-34627335

RESUMO

BACKGROUND: Few studies on rheumatoid arthritis (RA) have generated machine learning models to predict biologic disease-modifying antirheumatic drugs (bDMARDs) responses; however, these studies included insufficient analysis on important features. Moreover, machine learning is yet to be used to predict bDMARD responses in ankylosing spondylitis (AS). Thus, in this study, machine learning was used to predict such responses in RA and AS patients. METHODS: Data were retrieved from the Korean College of Rheumatology Biologics therapy (KOBIO) registry. The number of RA and AS patients in the training dataset were 625 and 611, respectively. We prepared independent test datasets that did not participate in any process of generating machine learning models. Baseline clinical characteristics were used as input features. Responders were defined as those who met the ACR 20% improvement response criteria (ACR20) and ASAS 20% improvement response criteria (ASAS20) in RA and AS, respectively, at the first follow-up. Multiple machine learning methods, including random forest (RF-method), were used to generate models to predict bDMARD responses, and we compared them with the logistic regression model. RESULTS: The RF-method model had superior prediction performance to logistic regression model (accuracy: 0.726 [95% confidence interval (CI): 0.725-0.730] vs. 0.689 [0.606-0.717], area under curve (AUC) of the receiver operating characteristic curve (ROC) 0.638 [0.576-0.658] vs. 0.565 [0.493-0.605], F1 score 0.841 [0.837-0.843] vs. 0.803 [0.732-0.828], AUC of the precision-recall curve 0.808 [0.763-0.829] vs. 0.754 [0.714-0.789]) with independent test datasets in patients with RA. However, machine learning and logistic regression exhibited similar prediction performance in AS patients. Furthermore, the patient self-reporting scales, which are patient global assessment of disease activity (PtGA) in RA and Bath Ankylosing Spondylitis Functional Index (BASFI) in AS, were revealed as the most important features in both diseases. CONCLUSIONS: RF-method exhibited superior prediction performance for responses of bDMARDs to a conventional statistical method, i.e., logistic regression, in RA patients. In contrast, despite the comparable size of the dataset, machine learning did not outperform in AS patients. The most important features of both diseases, according to feature importance analysis were patient self-reporting scales.


Assuntos
Antirreumáticos , Artrite Reumatoide , Reumatologia , Espondilite Anquilosante , Antirreumáticos/uso terapêutico , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/tratamento farmacológico , Humanos , Aprendizado de Máquina , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/tratamento farmacológico
15.
Praxis (Bern 1994) ; 110(14): 778-784, 2021.
Artigo em Alemão | MEDLINE | ID: mdl-34702056

RESUMO

CME Rheumatology 24: DISH of the Hand and Undifferentiated Polyarthritis Abstract. We present a case with undifferentiated, unclassified polyarthritis and with peripheral diffuse idiopathic skeletal hyperostosis (DISH). We discuss the differential diagnoses of "seronegative" polyarthritis and explain the radiographic findings of the little-known peripheral aspects of DISH.


Assuntos
Artrite , Hiperostose Esquelética Difusa Idiopática , Reumatologia , Artrite/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Hiperostose Esquelética Difusa Idiopática/diagnóstico
16.
Rheumatol Int ; 41(12): 2091-2103, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34596719

RESUMO

The Coronavirus disease 2019 (COVID-19) outbreak turned out the greatest pandemic for decades. It challenged enormously the global health system, forcing it to adjust to the new realities. We aimed to analyze articles covering COVID-19 papers in the rheumatological field and outline emerging topics raising within this frame. We applied the bibliometric database Scopus for our literature search and conducted it on the 5th of June using the following keywords: "rheumatic" OR "rheumatology" OR "rheumatoid arthritis" OR "systemic lupus erythematosus" OR "myositis" OR "systemic sclerosis" OR "vasculitis" OR "arthritis" OR "ankylosing spondylitis" AND "COVID-19". We analyzed all selected articles according to various aspects: type of document, authorship, journal, citations score, rheumatology field, country of origin, language, and keywords. With the help of the software tool VOSviewer version 1.6.15, we have built the visualizing network of authors and keywords co-occurrence. The measurement of the social impact of articles was made using Altmetric data. This study included 1430 retrieved articles with open access mostly. The top five journals in this field were Annals of the Rheumatic Diseases (n = 65), Rheumatology International (n = 51), Clinical Rheumatology (n = 50), Lancet Rheumatology (n = 50), and Frontiers In Immunology (n = 33). Most studies originate from countries with a high incidence of COVID-19 among the general population (the USA-387; Italy-268; UK-184; France-114; Germany-110; India-98 and Spain-96, China-94, Canada-73 Turkey-66). Original Articles (42.1%) were the most common articles' type, following by Letters (24.4%), Reviews (21.7%), Notes (6%), Editorials (4.8%), Erratum (1%). According to the citations scores, articles dedicated to the clinical course of COVID-19 in patients with rheumatic diseases were of the highest importance for the scientific rheumatologic community. Rheumatoid arthritis (n = 527), systemic lupus erythematosus (n = 393), vasculitis (n = 267), myositis (n = 71), systemic sclerosis (n = 68), and psoriatic arthritis (n = 68) were the most widely discussed rheumatic diseases in the view of COVID-19. The analysis of Altmetric and citations scores revealed a moderate correlation between them. This article provides a comprehensive bibliometric and altmetric analysis of COVID-19 related articles in the rheumatology field and summarizes data about features of rheumatology service in the time of the pandemic.


Assuntos
Bibliometria , COVID-19 , Reumatologia , COVID-19/epidemiologia , Feminino , Humanos , Masculino , Pandemias , Gravidez , Reumatologia/estatística & dados numéricos , Reumatologia/tendências , SARS-CoV-2
17.
Rheumatol Int ; 41(12): 2105-2108, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34622311

RESUMO

Data regarding COVID-19 vaccine efficacy and adverse events (AE) in patients with autoimmune and inflammatory rheumatic diseases (AIIRD) have been published recently although these mostly include the mRNA vaccines (Pfizer-BioNTech and Moderna) and the ChAdOx1 nCoV-19/AZD1222 (Oxford-AstraZeneca). This research aimed to study the prevalence of AE presented with six different SARS-CoV-2 vaccines {ChadOX1 nCoV-19 (AZD1222), Ad5-nCoV2, Ad26.COV2.S, mRNA-1273, BNT162b2, and CoronaVac} in Mexican patients with AIIRD. We performed a cross-sectional study about vaccine history. Two hundred and twenty five consecutive patients were recruited, mean age was 50.7 years and the majority (n = 213; 94.6%) were females. One hundred and seven (47.5%) received BNT162b2 mRNA, 34 (15.1%) Ad5-nCoV, 29 (12.8%) mRNA-1273, 28 (12.4%) ChAdOX1 nCoV-19 (AZD1222), 22 (9.7%) CoronaVac and 5 (2.2%) Ad26.COV2.S. The vaccines that had the most AE proportionally to the number of patients vaccinated were Janssen (5; 100%) followed by Pfizer-BioNTEch (86; 80%) and CanSinoBIO (27; 79.4%). Localized pain was the most frequent (158; 70.2%) AE. Fatigue (78; 34.7%), headache (69; 30.6%) and muscle ache (66; 29.3%) were the most common systemic symptoms. No serious AE that required medical attention or hospitalization were reported. The current results support the safety of different COVID-19 vaccines in patients with AIIRD. This information can help fight vaccine hesitancy in this population.


Assuntos
Vacinas contra COVID-19/efeitos adversos , Doenças Reumáticas/imunologia , Vacinação/estatística & dados numéricos , COVID-19/epidemiologia , COVID-19/imunologia , Vacinas contra COVID-19/administração & dosagem , Vacinas contra COVID-19/imunologia , Estudos Transversais , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Pandemias , Doenças Reumáticas/complicações , Reumatologia , SARS-CoV-2 , Inquéritos e Questionários
18.
Rheum Dis Clin North Am ; 47(4): 531-543, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34635290

RESUMO

The Childhood Arthritis & Rheumatology Research Alliance (CARRA) launched in 2000 as a small network of pediatric rheumatologists and investigators dedicated to promoting collaborative research to improve the care and outcomes of childhood-onset rheumatic diseases. Over the past 2 decades, CARRA has grown to become a major driver of advances in evidence-based medicine and career development in pediatric rheumatology. Its research approach has transformed pediatric rheumatology. CARRA is a vibrant organization that will continue to facilitate impactful research in the care of children, adolescents, and young adults with rheumatic disease in the years to come.


Assuntos
Artrite Juvenil , Doenças Reumáticas , Reumatologia , Adolescente , Criança , Humanos , Doenças Reumáticas/terapia , Adulto Jovem
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