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Rheumatoid factor testing in Spanish primary care: A population-based cohort study including 4.8 million subjects and almost half a million measurements / Uso del factor reumatoide en atención primaria en España: estudio de cohortes poblacionales incluyendo 4.8 millones de participantes y casi medio millón de mediciones
Morsley, Klara; Miller, Anne; Luqmani, Raashid; Fina-Aviles, Francesc; Javaid, Muhammad Kassim; Edwards, Christopher J; Pinedo-Villanueva, Rafael; Medina, Manuel; Calero, Sebastian; Cooper, Cyrus; Arden, Nigel; Prieto-Alhambra, Daniel.
Afiliação
  • Morsley, Klara; The Royal Berkshire NHS Foundation Trust. Royal Berkshire Hospital. Department of Rheumatology. Reading. United Kingdom
  • Miller, Anne; Oxford University Hospitals NHS Trust. Nuffield Orthopaedic Centre. Department of Rheumatology. Oxford. United Kingdom
  • Luqmani, Raashid; University of Oxford. Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences. Oxford. United Kingdom
  • Fina-Aviles, Francesc; Institut Català de la Salut. Direcció de Sistemes d'Informació. Barcelona. Spain
  • Javaid, Muhammad Kassim; University of Oxford. Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences. Oxford. United Kingdom
  • Edwards, Christopher J; University of Southampton. NIHR Wellcome Trust Clinical Research Facility. United Kingdom
  • Pinedo-Villanueva, Rafael; University of Oxford. Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences. Oxford. United Kingdom
  • Medina, Manuel; Institut Català de la Salut. Direcció de Sistemes d'Informació. Barcelona. Spain
  • Calero, Sebastian; Institut Català de la Salut. Direcció de Sistemes d'Informació. Barcelona. Spain
  • Cooper, Cyrus; University of Oxford. Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences. Oxford. United Kingdom
  • Arden, Nigel; University of Oxford. Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences. Oxford. United Kingdom
  • Prieto-Alhambra, Daniel; University of Oxford. Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences. Oxford. United Kingdom
Reumatol. clín. (Barc.) ; 15(6): 350-354, nov.-dic. 2019. tab, graf
Article em En | IBECS | ID: ibc-189652
Biblioteca responsável: ES1.1
Localização: BNCS
ABSTRACT
OBJECTIVE: Rheumatoid factor (RF) testing is used in primary care in the diagnosis of rheumatoid arthritis (RA); however a positive RF may occur without RA. Incorrect use of RF testing may lead to increased costs and delayed diagnoses. The aim was to assess the performance of RF as a test for RA and to estimate the costs associated with its use in a primary care setting. MATERIAL AND METHODS: A retrospective cohort study using the Information System for the Development of Research in Primary Care database (contains primary care records and laboratory results of >80% of the Catalonian population, Spain). Participants were patients ≥18 years with ≥1 RF test performed between 01/01/2006 and 31/12/2011, without a pre-existing diagnosis of RA. Outcome measures were an incident diagnosis of RA within 1 year of testing, and the cost of testing per case of RA. RESULTS: 495,434/4,796,498 (10.3%) patients were tested at least once.107,362 (21.7%) of those tested were sero-positive of which 2768 (2.6%) were diagnosed with RA within 1 year as were 1141/388,072 (0.3%) sero-negative participants. The sensitivity of RF was 70.8% (95% CI 69.4-72.2), specificity 78.7% (78.6-78.8), and positive and negative predictive values 2.6% (2.5-2.7) and 99.7% (99.6-99.7) respectively. Approximately €3,963,472 was spent, with a cost of €1432 per true positive case. CONCLUSIONS: Although 10% of patients were tested for RF, most did not have RA. Limiting testing to patients with a higher pre-test probability would significantly reduce the cost of testing
RESUMEN
OBJETIVOS: El factor reumatoide (FR) se usa en atención primaria para el diagnóstico de la artritis reumatoide (AR); sin embargo, un FR positivo puede observarse en sujetos sin AR, y su uso inapropiado puede conllevar costes y retraso diagnóstico. En este contexto, estudiamos la utilidad y costes del FR como test diagnóstico de la AR en atención primaria. MÉTODOS: Estudio de cohortes retrospectivas basadas en datos de historia clínica informatizada de >80% de la población de Cataluña (SIDIAP). Se incluyeron sujetos de edad ≥18 años y con ≥1 medida de FR entre el 1/1/2006 y el 31/12/2011, sin diagnóstico previo de AR. El diagnóstico incidente de AR durante el año posterior a la medida de FR, y el coste por caso de AR fueron las medidas de interés. RESULTADOS: 495.434/4.796.498 (10,3%) pacientes tuvieron al menos una medida de FR 107.362 (21,7%) de estos fueron sero-positivos, de los cuales solo 2.768 (2,6%) fueron diagnosticados de AR en el año siguiente, comparado a 1.141/388.072 (0,3%) diagnósticos en sero-negativos. La sensibilidad del FR fue del 70,8% (IC 95%: 69,4 a 72,2%), especificidad 78,7% (78,6 a 78,8%), y valor predictivo positivo y negativo 2,6% (2,5 a 2,7%) y 99,7% (99,6 a 99,7%), respectivamente. El coste total estimado fue de 3.963,472€, alrededor de 1.432€ por caso de AR diagnosticado. CONCLUSIONES: Aunque el 10% de participantes (casi medio millón de personas) fueron sujetos de medición/es de FR, la mayoría no desarrollaron AR. El uso de FR en pacientes con mayor probabilidad pre-test reduciría de forma significativa su coste
Assuntos

Texto completo: 1 Coleções: 06-national / ES Base de dados: IBECS Assunto principal: Artrite Reumatoide / Fator Reumatoide Limite: Adult / Aged / Female / Humans / Male País/Região como assunto: Europa Idioma: En Revista: Reumatol. clín. (Barc.) Ano de publicação: 2019 Tipo de documento: Article

Texto completo: 1 Coleções: 06-national / ES Base de dados: IBECS Assunto principal: Artrite Reumatoide / Fator Reumatoide Limite: Adult / Aged / Female / Humans / Male País/Região como assunto: Europa Idioma: En Revista: Reumatol. clín. (Barc.) Ano de publicação: 2019 Tipo de documento: Article