The REAL study: a nationwide prospective study of rheumatoid arthritis in Brazil

Abstract

Background: There are few data on the epidemiology, clinical manifestations and management of RA in Brazil, even with the recognition of the high direct, indirect and societal costs of this disease. Herein, we report the formation of the REAL -Rheumatoid Arthritis in Real Life, the first nationally representative multicenter prospective observational study in Brazil. Methods: The REAL study was designed to include a total of 1300 evaluable patients from 13 tertiary care public health centers specialized in RA management and representative of 5 regions of Brazil. Each center was expected to enroll~100 consecutively seen patients and follow them prospectively in a systematic protocol-driven fashion with scheduled visits at baseline, 6 and 12 months. Core clinical, laboratory and patient-reported outcomes measures were required to be collected at each visit. Results: A total of 1115 patients (89.4% female, mean age of 56.7 years and median disease duration of 12.7 years) were enrolled from 11 participating centers. Almost 80% of patients were of middle-low or low socioeconomic classes. The median educational time was 8 years, with 3.23% being below literacy level. The interval between symptoms and diagnosis varied from 1 to 457 months (median 12 months). Almost half of the patients were on glucocorticoids, 96.5% on DMARDs, with 35.7% on biologics. Median HAQ-DI was 0.875, ranging from 0 to 3. Median DAS28-ESR was 3.5, with 58.7% of patients presenting moderate or high disease activity. Conclusions:The first large cohort of Brazilian patients with RA in a real-life setting shows several striking differences from previously published cohorts from other countries. The long delay for diagnosis and start of DMARDs may partly explain the high frequency of erosive disease. An elevated percentage of patients on moderate or high disease activity was seen, despite of the high frequency of corticosteroid and biologics utilization. Data from this cohort may enable public health managers of developing countries better allocate the limited resources available for the care of RA patients.

Discordance between the patient’s and physician’s global assessment in rheumatoid arthritis: Data from the REAL study—Brazil

“…Patients were followed-up for approximately 12 months with systematic data collection at the initial visit (baseline), intermediate visit (6 months ± 1 month), and final visit (12 months ± 1 month) with an additional descriptive report of any other unscheduled visit. The present study is a cross-sectional evaluation of the data collected during the initial visit [14].…”

“…Almost half of the patients used glucocorticoids; among them, 96.5% used DMARDs, and 35.7% used biologics [14].…”

Real - rheumatoid arthritis in real life - study cohort: a sociodemographic profile of rheumatoid arthritis in Brazil

“…This work is part of a Brazilian multicentric study called REAL-Rheumatoid Arthritis in Real Life in Brazil, which is a prospective observational cohort study of patients with RA from 11 public healthcare centers in different geographic regions of Brazil that are specialized in RA management. For the present article, a cross-sectional cohort was analyzed, corresponding to the initial assessment of the participants, who were accompanied afterwards for a 12-month period [8].…”

“…School level: divided into below literacy level, first grade not complete, first grade complete, second grade not complete, second grade complete, higher grade not complete, higher grade complete and postgraduate. Employment situation: divided into retired, housewife, receiving disability benefit or retired temporarily by INSS (National Social Security Institute), unemployed, unemployed looking for work in the last 3 months, formally employed worker, self-employed worker, unregistered selfemployed worker, and informally employed, completed by means of an individual questionnaire after explanations [8]. Only one option could be chosen.…”

“…Time from symptoms to first DMARD, in months. Economic Classification: determined by the Brazilian Economic Classification Criterion (BECC), a score system updated in 2015 that includes variables such as the number of household electrical appliances, level of education of the householder and access to public services [8]. The score range is stratified from A to D-E, with each stratum corresponding to an estimated household income.…”