A Worse Functional Ability Is Associated With High Annual Direct Medical Costs in Patients With Rheumatoid Arthritis From a Social Security Hospital

Abstract

In Medellin, the outpatient pediatric rheumatology service started formally at mid 2002. Misdiagnosis has negative consequences, it is important patients are referred in a timely manner. Aim: To evaluate patterns of referral, degree of agreement and the diagnostic accuracy by referring physicians of the outpatient service of pediatric rheumatology at the Hospital San Vicente de Paul and, Pablo Tobón Uribe. Methods: Retrospective agreement study. Patients under age 18, referred with suspected rheumatic diseases at the mentioned hospitals, in a 30 month period, were included. Patients without diagnosis in the remission chart and without final rheumatic diseases diagnosis were excluded. Demographics characteristics, clinical manifestations, remission diagnosis and final diagnosis were assessed. The referring physician diagnoses were compared with the pediatric rheumatologist diagnosis. The agreement with the final diagnosis was evaluated using kappa statistic (k) and the accuracy indexes (sensitivity, specificity, like hood ratios), for referring physicians were calculated. The final diagnoses by pediatrics rheumatologist were used as the gold standard. Diseases were established by the standard criteria. For the statistic analysis STATA 8.0 was used. Results: 367 patients were evaluated at the time of the study, 286 (77) had rheumatologic diseases, 35 of these ones didn't have remission diagnosis, so they were excluded. 60.1% were females, mean age 9.47 years. Pediatrics was the most referring physicians 42.6%; follow by orthopedics surgeons, internist, adult rheumatologist, nephrologists and dermatologist. In the 13.9% the referred physician, was not known. Remission diagnosis was JRA 27.8%, LE 20.3%, (SLE, neonatal lupus, discoid lupus) febrile syndrome 6.8% and rheumatic fever 4.8%, the latest was not confirmed in any patient. The agreement was almost perfect for Henoch Schönlein purpura (K 0.88) and LE (K 0.85), and very good for JRA (K 0.61). Diagnostic precision for referring physicians was Sensitivity: 82.26, 64.52 and specificity: 77.73, 93.67 for JRA and LE respectively. The dermatologist showed the best agreement (100%), however all patients were referred for scleroderma treatment instead of diagnosis. The second place was for nephrologists (77.7%) Pediatrics agreement was only 54.2%. Conclusion:The global agreement with the final diagnosis was 58.2%, with a very good kappa index for JRA and almost perfect for LE, which are the most frequent diseases. However 41.8% of the remission diagnosis were changed, so a better effort in pediatrics programs is required to lower the morbimortality associated to the under and over diagnosis in the pediatric population with rheumatic diseases. Aim:To evaluate the prevalence of osteoporosis (OP) and osteopenia (op) in women over 50 years in the city of Lima Metropolitana according to the criteria of the WHO through a complete DXA densitometry. Methods: We calculated the sample size considering: a OP expected prevalence ϭ 16%, a estimated loss of 33% and data from Instit...