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Carvalho JS, dos Reis Neto ET, Kakehasi AM, Ribeiro SLE, Studart SAS, Martins FP, Cavalheiro do Espírito Santo R, Ranzolin A, Fernandino DC, Dinis VG, Sato EI, Resende GG, Marinho A, Mariz HA, Sacilotto NC, Ribeiro FM, Shinjo SK, Dias LH, Yazbek MA, Omura F, Rached THS, Gomides APM, Marques CDL, Pillegi GCS, Mota LMH, Pinheiro MM, Monticielo OA, Xavier RM, Ferreira GA. Factors associated with poor outcomes in SLE patients with COVID-19: Data from ReumaCoV-Brazil register. Lupus 2022; 32:42-53. [PMID: 36300790 PMCID: PMC9614598 DOI: 10.1177/09612033221135884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To evaluate factors associated with COVID-19 severity outcomes in patients with systemic lupus erythematosus (SLE). METHODS This was a cross-sectional analysis of baseline data of a prospective, multi-stage cohort study-"The ReumaCoV Brazil"-designed to monitor patients with immune-mediated rheumatologic disease (IMRD) during the SARS-CoV-2 pandemic. SLE adult patients with COVID-19 were compared with those without COVID-19. SLE activity was evaluated by the patient global assessment (PGA) and SLE Disease Activity Index 2000 (SLEDAI-2K). RESULTS 604 SLE patients were included, 317 (52.4%) with COVID-19 and 287 (47.6%) in the control group. SLE COVID-19 patients reported a lower frequency of social isolation and worked more frequently as health professionals. There was no difference in the mean SLEDAI-2K score between groups in the post-COVID-19 period (5.8 [8.6] vs. 4.5 [8.0]; p = 0.190). However, infected patients reported increased SLE activity according to the Patient Global Assessment (PGA) during this period (2.9 [2.9] vs. 2.3 [2.6]; p = 0.031. Arterial hypertension (OR 2.48 [CI 95% 1.04-5.91], p = 0.041), cyclophosphamide (OR 14.32 [CI 95% 2.12-96.77], p = 0.006), dyspnea (OR: 7.10 [CI 95% 3.10-16.23], p < 0.001) and discontinuation of SLE treatment medication during infection (5.38 [CI 95% 1.97-15.48], p = 0.002), were independently associated with a higher chance of hospitalization related to COVID-19. Patients who received telemedicine support presented a 67% lower chance of hospitalization (OR 0.33 [CI 95% 0.12-0.88], p = 0.02). CONCLUSION Hypertension and cyclophosphamide were associated with a severe outcome, and telemedicine can be a useful tool for SLE patients with COVID-19.
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Affiliation(s)
- Joana S Carvalho
- Programa de Pós-graduação em Ciências Aplicadas a Saúde do Adulto, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil,Joana S Carvalho, Programa de Pós-graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina, Universidade Federal de Minas Gerais, Alfredo Balena avenue, 190. Belo Horizonte-MG 13130-100, Brazil.
| | | | - Adriana M Kakehasi
- Programa de Pós-graduação em Ciências Aplicadas a Saúde do Adulto, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Sandra LE Ribeiro
- Faculdade de Medicina da Universidade Federal do Amazonas, Manaus, Brazil
| | | | - Francielle P Martins
- Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
| | - Rafaela Cavalheiro do Espírito Santo
- Hospital de Clínicas de Porto Alegre, Serviço de Reumatologia, Universidade Federal do Rio Grande do Sul, Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Porto Alegre, Brazil
| | | | - Diana C Fernandino
- Hospital Universitário, Universidade Federal de Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | | | - Emília I Sato
- Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Gustavo G Resende
- Programa de Pós-graduação em Ciências Aplicadas a Saúde do Adulto, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Henrique A Mariz
- Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Brazil
| | - Nathália C Sacilotto
- Instituto de Assistência Médica ao Servidor Público Estadual de S. Paulo, São Paulo, Brazil
| | - Francinne M Ribeiro
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Samuel K Shinjo
- Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Laiza H Dias
- Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Michel A Yazbek
- Hospital de Clínicas, Universidade Estadual de Campinas, Campinas, Brazil
| | - Felipe Omura
- Clínica Omura Medicina Diagnóstica, São Paulo, Brazil
| | - Thiago HS Rached
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
| | | | - Claudia DL Marques
- Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Brazil
| | | | - Lícia MH Mota
- Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
| | - Marcelo M Pinheiro
- Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Odirlei A Monticielo
- Hospital de Clínicas de Porto Alegre, Serviço de Reumatologia, Universidade Federal do Rio Grande do Sul, Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Porto Alegre, Brazil
| | - Ricardo M Xavier
- Hospital de Clínicas de Porto Alegre, Serviço de Reumatologia, Universidade Federal do Rio Grande do Sul, Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Porto Alegre, Brazil
| | - Gilda A Ferreira
- Programa de Pós-graduação em Ciências Aplicadas a Saúde do Adulto, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Gomides APM, Albuquerque CP, Santos ABV, Amorim RBC, Bértolo MB, Júnior PL, Santos IA, Giorgi RD, Sacilotto NC, Radominski SC, Borghi FM, Guimarães MFBR, Pinto MRC, Resende GG, Bonfiglioli KR, Carriço H, Sauma MFLC, Sauma ML, Medeiros JB, Pereira IA, Castro GRW, Brenol CV, Xavier RM, Mota LMH, Pinheiro GRC. High Levels of Polypharmacy in Rheumatoid Arthritis-A Challenge Not Covered by Current Management Recommendations: Data From a Large Real-Life Study. J Pharm Pract 2019; 34:365-371. [PMID: 31451091 DOI: 10.1177/0897190019869158] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is associated with high frequency of comorbidities and increased risk of polypharmacy. Although there is a great potential for complications, there is a gap in literature on polypharmacy in patients with rheumatic arthritis. OBJECTIVE To evaluate the prevalence and factors associated with polypharmacy in a population in a real-life setting. METHODS A cross-sectional multicenter study was conducted in Brazil. Patients underwent clinical evaluation and medical records analysis. Polypharmacy was considered as a dependent variable. To test independent variables, we used Poisson regression. RESULTS We evaluated 792 patients (89% female, median age 56.6 years). Median duration of disease was 12.7 years, 78.73% had a positive rheumatoid factor. The median of disease activity score-28 was 3.5 (disease with mild activity), median of the clinical disease activity index score was 9, and median of health assessment questionnaire-disability index was 0.875; 47% used corticosteroids, 9.1% used nonsteroidal anti-inflammatory drugs, 90.9% used synthetic disease-modifying antirheumatic drugs, 35.7% used biologic disease-modifying antirheumatic drugs (DMARDs). In total, 537 (67.9%) patients used 5 or more drugs. Polypharmacy showed a relationship with a number of comorbidities and use of specific drugs (corticosteroids, methotrexate, and biological DMARDs). CONCLUSION We found a high prevalence of polypharmacy (67.9%) in RA. Solutions to management this problem should be stimulated.
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Affiliation(s)
| | | | - Ana B V Santos
- 28130Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Paulo L Júnior
- Faculdade de Medicina da Universidade de Ribeirao Preto, 28133Universidade de Sao Paulo, Ribeirão Preto, Brazil
| | - Isabela A Santos
- Faculdade de Medicina da Universidade de Ribeirao Preto, 28133Universidade de Sao Paulo, Ribeirão Preto, Brazil
| | - Rina D Giorgi
- 74357Instituto de Assistência Médica ao Servidor Público Estadual, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil
| | - Nathália C Sacilotto
- 74357Instituto de Assistência Médica ao Servidor Público Estadual, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil
| | | | | | | | - Maria R C Pinto
- 28114Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | | | | | | | - Ivânio A Pereira
- 28117Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Gláucio R W Castro
- 28131Universidade do Sul de Santa Catarina-Unisul, Florianópolis, Brazil
| | - Claiton V Brenol
- 28124Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ricardo M Xavier
- 28124Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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