Objectives: Inform the recent advances of our early arthritis clinics network program sponsored by The Colombian Rheumatology Association (CRA) to this date. Methods: We asked rheumatologist to participate in a network of early arthritis clinics with the compromise of develop integrated policies and to fill similar standardized questionnaires in our centers and to respect decisions of general assembly of CRA. The CRA finance computers, software for data recollection (Arthros 6.1), and a visit lo Leiden Arthritis Clinic by representatives of each EAC besides of the Colombian protocol and early arthritis registry. Results: These are some achievements: We have completed evidence based clinical guidelines for rheumatoid arthritis, early rheumatoid arthritis, osteoarthritis and Ankylosing Spondylitis; we create a national network of early arthritis with 10 excellence centers trough the country in all major cities in which are working more than 57% of Colombian rheumatologists. They work in assistance to patients with similar policies trough the country and in to research. We are enrolling patients in "Cooperar" (Colombian protocol and Early Arthritis Registry) which consist in a standardized protocol and questionnaire with evaluations each 3 months of patients with early arthritis of less of one year of onset. We have included since May 2005 until know 158 patients. Conclusion: CRA helps to integrate rheumatologist of all around the country and permits to share unified work and protocols which are very important in current health system. Actually our guidelines are official papers for our health system and we hope results of Cooperar will help to establish early arthritis as a national policy in the care of rheumatic diseases. It permits significant collaborative work for the country in areas of low budget or few centers for research.Objectives: Describe frequency and characteristics of disability in a cohort of patients with RA in a population of Colombia. Methods: A Cross-sectional descriptive study in a cohort of patients that attend a University Hospital, a HMO rheumatology clinic and a private office. Consecutive patients with RA according ACR criteria who assist to the clinics were invited participate. A structured questionnaire with sociodemographic, work related information and disease related variables were evaluated. The disability was evaluated by means of the application of the Health Assessment Questionnaire (HAQ). The data were analyzed with the statistical software EPINFO 6.1. Results: To date 88 patients were included, 92% women, 73% mestizos, 53.5% low socioeconomic status (SES), 35.3% medium SES and 11.4% high SES. 59% refer incomes of 1 or fewer minimum wages (150 US), 23% 2 to 3 minimum wage (250 -350 US) and 18% more than 450 US. 71% they have a routine moderate physical activity. The HAQ average was 0.69 Ϯ 0.73 (0 -3); 51% they had HAQs of 0 -0.049, 22.7% of 0.5-0.99, 12.5% of 1-1.49, 5.7% of 1.5-1.99 and 8% of 2-3. Only 27.3% have formal employment with moderate physical activity in most patient...
Objective: To evaluate impact of age, gender, race and BMI on NSAID efficacy in OA. Methods: Pfizer Clinical Trials Registry was searched for studies meeting the following criteria: randomized parallel-group design; Ն1 treatment group receiving celecoxib Ն200 mg daily; Ն1 placebo, NSAID, or rofecoxib comparator group; planned duration of Ն6 weeks; study completed and report finalized by October 31, 2004; 1 primary OA efficacy end point and pain visual analog scale (VAS) of 100 mm collected. In analyzing efficacy, we used the minimal clinically important difference (MCID), which proposes that patients are unable to detect a small difference in efficacy. For MCID a change of Ն10 mm on the VAS from baseline to last observation was used to define responders. Percent responders and differences in responder rates were calculated for placebo and NSAIDs combined for age, gender, BMI, and race. For each treatment, responder rates were compared statistically for categorical data (gender and race) using a test of incidence rates within each treatment category, and CMH for overall association. For continuous variables (BMI and age), inference was calculated on the slope of the regression of VAS change on predictor variables. No adjustments in the nominal alpha level were made for the multiple analyses. Results: Fifteen studies were included: 21,798 OA patients received celecoxib (61%), diclofenac (19%), naproxen (10%), ibuprofen (1%), rofecoxib (2%), or placebo (8%). The majority of patients were female (73%) and Caucasian (78%). Median (range) for age and BMI were: 63 years (18 -96) and 29 (11-149), respectively. NSAID response was influenced significantly by age (P ϭ 0.0099), BMI (P ϭ 0.0002), gender and race (P Յ 0.0001); placebo response was influenced by age (P ϭ 0.0002) and race (P Յ 0.0001). Differential response between NSAIDs and placebo was significantly influenced by all variables (P Յ 0.0001). Conclusions: Age, gender, BMI, and race are important predictors of NSAID response, while only age and race influence placebo response. Predictors of the highest benefits of pain reduction with NSAIDs versus placebo are: older age, female sex, being overweight, and Caucasian race.
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