Rheumatoid arthritis in the indigenous qom population of Rosario, Argentina: aggressive and disabling disease with inadequate adherence to treatment in a community-based cohort study

Abstract

To describe the baseline and follow up epidemiological/clinical characteristics of rheumatoid arthritis (RA) in a community-based cohort of the qom population. RA (ACR criteria) patients identified (n = 40) or not (n = 25) in the previous study were included. Baseline and follow-up visits (3, 6, and 12 months) were performed. Treatment adherence and modification, disability (Health Assessment Questionnaire Disability Index-HAQ-DI), and Disease Activity [DAS-28 (ESR)] were ascertained. At 12 months, complete and incomplete lost to follow-up patients were identified. The estimated RA prevalence was 3%. The patients' mean (SD) disease duration was 110.5 (17.9) and their median delay in diagnosis 30.4 (IQR 52.8) months; mean (SD) age and years of formal education were 39.8 (1.6) and 5.3 (SD 0.3); 58 (89.2%) were female, and 89.2% were seropositive. At baseline, their mean DAS-28 (ESR) was 4.8 (SD 0.9) with 67.7% having high disease activity and 32.3% moderate; 76.9% reported HAQ-DI ≥ 0.8. At 12 months, three patients have died; 13 (20.9%) were "completely" and 19 (30.6%) "incompletely" lost to follow-up. There were favorable changes over time for disease activity (p ˂ 0.001), HAQ-DI (p ˂ 0.001), and treatment modifications (p ˂ 0.001) but no changes in treatment adherence (p = 0.260). The main cause of lost to follow-up was migration. This population has one of the highest RA prevalence rate reported. Patients had an aggressive and disabling disease, with poor adherence to treatment. Improvements of clinical parameters over time were observed.

Access to healthcare system of indigenous communities with musculoskeletal disorders and rheumatic disease in Chaco, Argentina: a qualitative study

“…Health is an important reason for the community to move from their hometown to urban areas looking for better opportunities. However, as mentioned before, this pattern is associated with low adherence to treatment [6].…”

“…The RA in the qom community is characterized as an aggressive disease, with poor adherence to clinical follow-up and treatment due to a migration pattern of moving from their hometown (province of Chaco) to urban areas [6]. GLADERPO's purpose is to build a network between the qom communities and the healthcare systems from the province of Chaco and the city of Rosario, allowing this migrant population to have access to healthcare regardless of their location and to improve adherence to medical treatment.…”

Afectación de la vida diaria y laboral en población Qom de Rosario (Argentina) con artritis reumatoidea

“…En la comunidad Qom de Rosario particularmente la prevalencia valorada por el Censo del 2014 fue del 2,4 %. Sin embargo, recientemente esta ascendió a un 3,0 % (Quintana et al, 2018). Si bien este indicador se ubicó muy por encima de las tasas generales en otros países de la región (Delgado et al, 2016; Muñetón y Quintana, 2015), estudios similares (McDougall, Hurd y Barnabe, 2017) indicaron mayores índices de artritis reumatoidea en poblaciones indígenas de Estados Unidos, Canadá, Australia y Nueva Zelanda.…”

“…En ocasiones, el retraso en el diagnóstico temprano de esta patología podría estar relacionado con la débil articulación entre el primer y segundo nivel de atención de salud para la entrega de turnos, a lo que se aúnan otras barreras estructurales para el acceso a los controles de salud de la población (Fernández et al, 2014). Si bien esta investigación no recopiló datos cuantitativos acerca de esta variable, estudios similares, como el de Quintana et al (2018), identificaron una demora en el diagnóstico de artritis reumatoidea de 4,4 años en el 50 % de los pacientes. En otro estudio realizado en Medellín se encontró una media de 11 años (Vinaccia et al, 2005), y en pacientes del estudio realizado en Australia el tiempo promedio era de 11,5 años (Radner, Smolen y Aletaha, 2014).…”

“…Por ello, en los últimos años, especialmente de la mano de organismos internacionales, ha crecido la preocupación y visibilización de la situación de salud de estas comunidades. Investigaciones recientes, como las de Fernández et al (2014) y Quintana et al (2018), han destacado la prevalencia de hipertensión y de determinadas patologías respiratorias o reumatológicas en población indígena de América Latina.…”