Latitude gradient influences the age of onset of rheumatoid arthritis : a worldwide survey

The age of onset of rheumatoid arthritis (RA) is an important outcome predictor. Northern countries report an age of RA onset of around 50 years, but apparently, variability exists across different geographical regions. The objective of the present study is to assess whether the age of onset of RA varies across latitudes worldwide. In a proof-of-concept cross-sectional worldwide survey, rheumatologists from preselected cities interviewed 20 consecutive RA patients regarding the date of RA onset (RAO, when the patient first noted a swollen joint). Other studied variables included location of each city, rheumatologist settings, latitudes (10A degrees increments, south to north), longitudes (three regions), intracountry consistency, and countries' Inequality-adjusted Human Development Index (IHDI). Data from 2481 patients (82% females) were obtained from 126 rheumatologists in 77 cities of 41 countries. Worldwide mean age of RAO was 44 +/- 14 years (95% CI 44-45). In 28% of patients, RA began before age 36 years and before age 46 years in 50% of patients. RAO was 8 years earlier around the Tropic of Cancer when compared with northern latitudes (p <0.001, 95% CI 3.5-13). Multivariate analysis showed that females, western cities, and latitudes around the Tropic of Cancer are associated with younger age of RAO (R (2) 0.045, p <0.001). A positive correlation was found between the age of RAO and IHDI (r = 0.7, p <0.01, R (2) 0.5). RA often begins at an early age and onset varies across latitudes worldwide. We postulate that countries' developmental status and their geographical and geomagnetic location influence the age of RAO.Peer reviewe

Treatment of Early Rheumatoid Arthritis in a Multinational Inception Cohort of Latin American Patients the GLADAR Experience

Background: Treatment of rheumatoid arthritis (RA) has evolved dramatically in the last decade. However, little is known about the way rheumatologists in Latin America treat their patients in clinical practice, outside the scope of clinical trials.Objective: the objective of this study was to describe treatment patterns at disease onset in early RA with data from a large, multicenter, multinational inception cohort of Latin American patients.Methods: Consecutive patients with early RA (<1 year of disease duration as diagnosed by a rheumatologist) from 46 centers in 14 Latin American countries were enrolled in the study. Clinical data, laboratory assessments, and a detailed registry on type of prescriptions were collected at baseline and at 3, 6, 12, 18, and 24 months of follow-up. Hands and feet x-rays were obtained at baseline and at 12 and 24 months. All data were captured in Arthros 6.1 database. Continuous variables were expressed as means and SDs, and categorical variables were expressed as percentages and 95% confidence intervals (95% CIs). Only therapeutic data at baseline are presented, corresponding to the period between disease onset and second visit (3 months).Results: A total of 1093 patients were included. Eighty-five percent were female, and 76% had a positive rheumatoid factor. Mean age at diagnosis was 46.5 (SD, 14.2) years, and mean disease duration at the first visit was 5.8 (SD, 3.8) months. Between baseline and second visit (3 months), 75% of patients (95% CI, 72%-78%) received disease-modifying antirheumatic drugs. Methotrexate (MTX) alone or in combination was the most frequently used (60.5%), followed by antimalarials (chloroquine or hydroxychloroquine, 32.1%), sulfasalazine (7.1%), and leflunomide (LEF, 4%). in 474 patients (43%), initiation of disease-modifying antirheumatic drugs was within the first month after the first visit. in addition, 290 patients (26%; 95% CI, 23%-29%) received combination therapy as initial treatment. the most frequently used combinations were MTX + chloroquine (45%), MTX + hydroxychloroquine (25%), and MTX + sulfasalazine (16%). Eleven patients (1%; 95% CI, 0.5%-1.8%) received biologics. Sixty-four percent (95% CI, 60%-66%) received corticosteroids. of those, 80% (95% CI, 77%-84%) received 10 mg of oral prednisone or less.Conclusions: in this cohort of Latin American patients with early RA, most patients received MTX very early in their disease course. Combination therapy was used approximately in 1 of every 4 patients as initial therapy. Biologics were rarely used at this early stage, and low-dose prednisone was commonly used.Abbott LaboratoriesAbbottHosp Italiano Buenos Aires, Serv Clin Med, Secc Reumatol, Buenos Aires, DF, ArgentinaFdn Dr Pedro M Catoggio Progreso Reumatol, Buenos Aires, DF, ArgentinaHosp Gen Dr Miguel Silva, Unidad Invest Dr Mario Alvizouri Munoz, Morelia, Michoacan, MexicoHosp Prov Rosario, Serv Reumatol, Rosario, Santa Fe, ArgentinaUniv Nacl Rosario, RA-2000 Rosario, ArgentinaHosp Privado, Ctr Med Cordoba, Dept Reumatol, Cordoba, ArgentinaHosp San Martin La Plata, Dept Reumatol, La Plata, Buenos Aires, ArgentinaUniv Fed Minas Gerais, Hosp Clin, Dept Aparelho Locomotor, Serv Reumatol, Belo Horizonte, MG, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Med Interna, Serv Reumatol, São Paulo, BrazilPontificia Univ Catolica Rio Grande do Sul, Dept Reumatol, Porto Alegre, RS, BrazilUniv Fed Parana, Hosp Clin, Dept Clin Med, Disciplina Reumatol, BR-80060000 Curitiba, Parana, BrazilHosp Geral Goiania Dr Alberto Rassi, Secao Reumatol, Goiania, Go, BrazilPontificia Univ Catolica Chile, Fac Med, Dept Clin Immunol & Rheumatol, Santiago, ChileHosp Clin San Borja Arriaran, Dept Reumatol & Inmunol, Santiago, ChileClin Univ Bolivariana, Corp Invest Biol, Dept Inmunol Clin & Reumatol, Medellin, Antioquia, ColombiaHosp Mil, Dept Reumatol & Inmunol, Bogota, ColombiaHosp Especialidades Ctr Med La Raza, Ctr Med Nacl Siglo 21, Dept Reumatol, Mexico City, DF, MexicoUniv Autonoma Nuevo Leon, Hosp Univ Dr Jose Eleuterio Gonzalez, Dept Med Interna, Serv Reumatol, Monterrey, Nuevo Leon, MexicoHosp Gen Occidente Secretaria Salud, Dept Inmunol & Reumatol, Zapopan, Jalisco, MexicoHosp Presidente Estrella Urena, Clin Corominas, Clin Union Med, Dept Reumatol, Santiago, Dominican RepHosp Univ Caracas, Minist Salud, Ctr Nacl Enfermedades Reumat, Serv Reumatol, Caracas, VenezuelaUniversidade Federal de São Paulo UNIFESP, Dept Med Interna, Serv Reumatol, São Paulo, BrazilWeb of Scienc