Rheumatoid arthritis in Latin America: the importance of an early diagnosis

Abstract

The generalization of the early rheumatoid arthritis (ERA) concept and the existence of a window of therapeutic opportunity—a time span in which the institution of a proper therapeutic method for the disease would determine clinical improvement—have set the notion that early diagnosis and treatment may modify the course of the disease. Although in several regions of the world, especially in North America and Europe, since the year 2000, a significant reduction in diagnostic delay was observed in cohorts of patients with rheumatoid arthritis (RA), probably reflecting a stronger awareness of the importance of early diagnosis, this is not a reality in Latin America (LA). LA is a region of great economic inequality, with disparities in access to the public healthcare system and limited access to private medicine, being widely difficult to obtain a specialized medical evaluation in both scenarios. This paper aims to briefly review the main difficulties in the management of ERA in LA, based on the review of the literature, on the evaluation of a survey conducted among 214 rheumatologists of LA, members of Pan-American League of Associations for Rheumatology (PANLAR) and the experience of the authors. The paper also aims to propose solutions to the difficulties in managing ERA in LA.

Rheumatoid artrhitis treatment in Brazil: data from a large real-life multicenter study

“…Biological DMARD use (36.1%) in our cohort was more frequent than in studies of early RA conducted in Brazil and Latin America [17,19,21]. Patients treated early in the course of disease are supposed to respond better and to require less of the more advanced resources, such as biological DMARDs, in the stepwise approach to RA management [23].…”

“…In other words, the Brazilian protocol for the management of RA does incorporate all relevant concepts and resources with proven efficacy in clinical trials. Nonetheless, concerns about extrapolating findings from controlled trials to larger uncontrolled scenarios, especially in less-favored economic backgrounds, are warranted [17,18]. The actual patterns of disease management in these population settings and their end results must be assessed through real-life data.…”

A global perspective on the challenges and opportunities in learning about rheumatic and musculoskeletal diseases in undergraduate medical education

“…Developed countries have seen a substantial reduction in the time to diagnosis for patients with rheumatoid arthritis, indicating greater awareness of the importance of early diagnosis [58]. However, this is not the case in regions of economic inequality with disparities in access to public healthcare and restricted access to private medicine [58,59]. As many patients with RMDs will ultimately present to nonspecialists [60], gaining basic adult and paediatric RMD knowledge and competencies should be a fundamental requirement of global undergraduate medical education.…”

Itinerário terapêutico de pacientes com artrite reumatoide em uso de medicamentos modificadores do curso da doença biológicos

“…tornozelos, e joelhos e presença de nódulo reumatoide, com duração de pelo menos seis semanas. 2,13 Inúmeros estudos internacionais demonstram o desafio que representa à saúde pública o diagnóstico precoce da AR [14][15][16][17][18][19][20][21] , e diversas estratégias já foram testadas para minimizar o tempo entre a ocorrência dos primeiros e o início do tratamento com medicamento modificador do curso da doença (MMCD), aproveitando a janela de oportunidade terapêutica da doença, e minimizando sua morbimortalidade. [22][23][24][25][26][27][28] O acesso ao médico especialista -reumatologista -constitui um dos gargalos para o diagnóstico precoce.…”

“…[22][23][24][25][26][27][28] O acesso ao médico especialista -reumatologista -constitui um dos gargalos para o diagnóstico precoce. [14][15][16][17][18][19][20][21] [14][15][16][17]20,21 Os primeiros sintomas de AR de fato podem ser confundidos com problemas musculoesqueléticos. 15 : para aumentar conhecimento dos pacientes e/ou encurtar o tempo para busca de cuidados médicos: criação de páginas na internet sobre o assunto por associações de pacientes e de reumatologistas, e campanhas de triagem e de educação sobre doenças osteomusculares; e para melhorar identificação da doença na atenção primária: oficinas e programas educacionais para profissionais da atenção primária, e aproximação destes com reumatologistas de forma sistemática e frequente para troca de conhecimento.…”