The prevalence of acute myocardial infarction was similar to that observed in other studies. Among the traditional risk factors, Diabetes Mellitus, and among the factors related to rheumatoid arthritis, disease duration, were the variables associated with comorbidity.

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Background: Rheumatoid arthritis primarily affects the working-age population and may cause key functional and work limitations. As the disease progresses, individuals become increasingly unable to conduct daily activities, which has a substantial personal and socioeconomic impact. Fairly recent prior studies showed that patients with RA stop working 20 years earlier than age-matched controls. Factors related to sociodemographic, clinical, care and disease profiles might affect the loss of work capacity. The purpose of this study was to assess the factors associated with the prevalence of working patients with rheumatoid arthritis in the municipality of Blumenau. Methods: A cross-sectional, population-based study was conducted between July 2014 and January 2015, with 296 individuals aged 20 years or older, male and female, living in Blumenau, Santa Catarina state, Brazil, and diagnosed with rheumatoid arthritis according to the 1987 American College of Rheumatology criteria. The prevalence of working patients with RA was assessed by employment status self-reporting during the interview. The chi-squared test, Wald test and Poisson regression analysis were used to test the possible associations between the independent variables and outcome. Results: The prevalence of working patients with rheumatoid arthritis was 44.3%. Patients aged 20 to 59 years had a 90% higher prevalence of outcome than subjects aged 60 years or older. The prevalence of working patients was 132% and 73% higher among individuals with low income and high functional disability, measured using the Health Assessment Questionnaire (HAQ), respectively. Conclusion: The prevalence of working RA patients was highest among adult patients with low income and high functional disability. The first variable is directly related to the individual characteristic, the second reflects the socioeconomic context of the patient, and the third reflects the degree of disability caused by the disease, which may be modifiable by health professionals.

During the observed period, a reduction in the number of hospital admissions for both clinical and orthopedic surgical procedures related to this disease was observed. Nevertheless, there was an increase in the cost of medical admissions.

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Background: Rheumatoid arthritis (RA) is an autoimmune inflammatory disease characterized by peripheral and symmetrical polyarthritis. It can be divided into Very Early Rheumatoid Arthritis (VERA) diagnosed up to 3 months of symptoms and late onset (Late Early Rheumatoid Arthritis-LERA), diagnosed between 3 and 12 months. Currently, it is recommended to evaluate the patient with joint symptoms as early as possible, and the first 12 weeks of manifestations represent the ideal phase for the diagnosis, favoring a better evolution of the treatment. The present study aimed to determine the prevalence of early diagnosis of rheumatoid arthritis, mean time of diagnosis and to determine possible associated factors in the municipality of Blumenau, Santa Catarina, Brazil. Methods: A cross-sectional study using the 1987 American College of Rheumatology diagnostic criteria to select patients attended at primary or secondary health care units in Blumenau, Santa Catarina, southern Brazil, in 2014. Diagnostic time was verified by self-report of the time elapsed between the onset of symptoms and the diagnosis made by a rheumatologist. To test the associations, the chi-square test, the Wald linear trend test and the Poisson regression analysis were used. Results: The mean time of diagnosis was 28 months. The prevalence of diagnosis up to 3 and 12 months was 27. 7% and 64.8%, respectively. Obesity was associated with time diagnosis in both periods. The 0-4 years category of the variable education was associated only with the period up to 12 months. Conclusion: The mean time of diagnosis was similar to the national context. Among socioeconomic factors, lower education was associated with the diagnosis of late onset RA. The anthropometric variable presented a progressive increase in the prevalence due to the longer time to diagnosis.

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BackgroundEpidemiological studies have established that rheumatoid arthritis is associated with an increase in cardiovascular disease1,2. The evaluation of tumour necrosis factor inhibitors (TNFi) on the reduction of the risk of acute myocardial infarction and death due to cardiovascular causes has shown promising results3. The economic evaluation for these outcomes are not established yet.ObjectivesTo evaluate the cost-effectiveness of TNFi versus disease-modifying antirheumatic drugs (Dmards) to avoid a new case of acute ischemic heart disease and death in rheumatoid arthritis patients.MethodsA cost-effectivenes analysis (CEA) was performed using a Markov model 6-month transition cycle, with time horizon of 30 years, under the Brazilian public healthcare system perspective. Costs are expressed in 2015 Reais and effectiveness measures are new cases of acute ischemic coronary disease and cardiovascular death.ResultsThe average cost in 30 years of Dmards and TNFi was 14,291,105.28 and 96,151,873.86 Reais, respectively. The incremental effectiveness was 2.69 cases of coronary artery disease and consequent incremental cost-effectiveness ratio (ICER) of 30,527,502.27 Reais per new cases avoided, while for cardiovascular death, incremental effectiveness was 1.33 and an ICER of 61,634,231,69 Reais per new cases avoided. The univariate analysis identified that the most relevant parameter in the ICER on both outcomes was the TNFi drug. The sensitivity analysis established that, in order to, reach the amount of willingness to pay (WTP) per semester to avoid an acute myocardial infarction, the average cost of TNFi should be 1,337.47 Reais per case avoided and the average cost for the cardiovascular death avoidence sould be 954.22 Reais. All the analyzes performed establish an unfavorable relationship of the drug treatment strategy with TNFi.ConclusionsThe findings of the CEA among patients with rheumatoid arthritis for cardiovascular outcomes when compared to the strategy of TNFi drug treatment with the dominant strategy Dmards after the first 6 months of exposure point out an unfavorable relationship, surpassing the amount of expenses recommended by the Ministry of Health of Brazil in the year 2015.References Symmons DP, Gabriel SE. Epidemiology of CVD in rheumatic disease, with a focus on RA and SLE. Nat Rev Rheumatol. 2011;7(7):399–408.Bergström U, Jacobsson LT, Turesson C. Cardiovascular morbidity and mortality remain similar in two cohorts of patients with long-standing rheumatoid arthritis seen in 1978 and 1995 in Malmö, Sweden. Rheumatology (Oxford). 2009;48(12):1600–5.Dixon WG, Watson KD, Lunt M, Hyrich KL; British Society for Rheumatology Biologics Register Control Centre Consortium. Reduction in the incidence of myocardial infarction in patients with rheumatoid arthritis who respond to anti-tumor necrosis factor alpha therapy: results from the British Society for Rheumatology Biologics Register. Arthritis Rheum. 2007;56(9):2905–12. AcknowledgementsFoundation for Research Support of the State of São Paulo, FAPESP 2...