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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Rheumatoid arthritis &#40;RA&#41; is an autoimmune disease and most patients have a chronic&#44; fluctuating progression&#46; If untreated&#44; it leads to progressive joint deformity&#44; disability and premature death&#46; The onset of early treatment with disease modifying drugs &#40;DMARD&#41; reduces disability at 5 years&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The objective of treatment in patients with recent onset RA is the suppression of disease activity before joint damage is established&#59; this justifies the importance of opportune therapeutic intervention&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> Patients treated early &#40;during the first three months since disease onset&#41; have a better prognosis and may go into disease remission&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Studies performed to evaluate time between disease onset and time of diagnosis and start of adequate treatment are scarce<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;9</span></a> and none exist in Mexico&#46; The objective of the study was to evaluate the time since the beginning of disease and the visit to the family physician&#44; the time since this and the referral to the rheumatologist and the time to onset of DMARD treatment&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We included&#44; from January to December 2010&#44; adult patients with clinical manifestations of RA and no previous evaluation by a rheumatologist or DMARD treatment&#46; Patients were sent to different family physicians or from the internal medicine specialist to the rheumatologist of a regional General Hospital of the Instituto Mexicano Seguro Social &#40;IMSS&#41;&#46; We defined RA based on the 1987 criteria proposed by the American College of Rheumatology&#46; We evaluated the following timelines&#58; time from onset of symptoms to the visit to the family physician&#59; time from disease onset to the first visit to the rheumatologist and time since disease onset and DMARD treatment onset&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Mean age&#177;SD of the 98 patients was 38&#177;9 years&#59; 85&#37; were female&#59; 49 had an RA disease progression of 1&#8211;6 months&#44; the diagnosis established by the family physician was RA in 79&#37; of patients and the mean number&#177;SD of visits the patient received before referral to rheumatology was 6&#46;6&#177;5&#46;8&#41;&#46; In 19&#44; 33&#44; 23 and 24&#37; of patients&#44; the onset of DMARD treatment was 1&#8211;3&#44; 4&#8211;6&#44; 7&#8211;12 and &#8805;13 months after RA symptom onset&#44; respectively&#46; The mean time for the patient to receive medical attention was 2&#46;9 months&#44; and for referral to Rheumatology from primary care was 6&#46;6 months&#46; For DMARD treatment onset it was 9&#46;9 months&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Our results show that only in 19&#37; of patients was DMARD started in the first three months after disease onset and the delay in the prescription of DMARD was mainly due to the delay in referral from family medicine to the rheumatologist&#46; Studies performed in the past 2 decades which evaluate the onset of DMARD treatment in patients with early RA&#44; performed in the US&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Spain&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Canada&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> the United Kingdom&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> the Middle East&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and in European countries&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> show that the mean time since the onset of disease and the onset of DMARD treatment ranges from 6 to 18 months&#44; similar to our findings &#40;mean 11 months&#41;&#46; This indicates that the diagnosis of RA after the onset of symptoms is delayed and&#44; therefore&#44; the objective of starting treatment early is not achieved in most cases&#46; Less than 30&#37; of RA patients receive DMARD treatment in the first 3 months&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;9&#44;10</span></a> It is necessary to implement measures that act on early diagnosis and treatment of RA&#44; through the diffusion of knowledge relating to the disease in the general population&#44; advertising campaigns as well as an increase in the level of knowledge regarding RA in primary care physicians&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Zonana Nacach A&#44; Campa&#241;a-Parra A&#44; Santana-Sahag&#250;n JE&#46; Tiempo entre comienzo de s&#237;ntomas&#44; acudir al m&#233;dico e inicio de f&#225;rmacos modificadores de la enfermedad en pacientes con artritis reumatoide&#46; Reumatol Clin&#46; 2014&#59;10&#58;131&#8211;132&#46;</p>"
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                  "contribucion" => array:1 [
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                      "titulo" => "The effectiveness of early treatment with second line antirreheumatic drugs&#58; a randomised controlled trial"
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                          "etal" => true
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                            0 => "A&#46; Van der Heide"
                            1 => "J&#46;W&#46; Jacobs"
                            2 => "W&#46;A&#46; Biglsma"
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                            5 => "M&#46;J&#46; van der Veen"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "1996"
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                          "autores" => array:6 [
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                            1 => "P&#46; Hammonnen"
                            2 => "M&#46; Leirisalo-Rapo"
                            3 => "M&#46; Nissila"
                            4 => "H&#46; Kauntiamen"
                            5 => "M&#46; Korpela"
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                      "doi" => "10.1016/S0140-6736(97)01300-7"
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Letter to the Editor
The Lag Time Between Onset of Symptoms, Medical Encounter, and Initiation of Disease Modifying Antirheumatic Drugs in Patients With Rheumatoid Arthritis
Tiempo entre comienzo de síntomas, acudir al médico e inicio de fármacos modificadores de la enfermedad en pacientes con artritis reumatoide
Abraham Zonana Nacacha,
Corresponding author
zonanaa@yahoo.com

Corresponding author.
, Alfredo Campaña-Parrab, Jesús Ernesto Santana-Sahagúnb
a Unidad de Investigación Clínica y Epidemiología, Hospital General Regional N.° 20, Instituto Mexicano del Seguro Social, Tijuana, Baja California, Mexico
b Consulta externa Reumatología, Hospital General Regional N.° 20, Instituto Mexicano del Seguro Social, Tijuana, Baja California, Mexico
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    "titulo" => "The Lag Time Between Onset of Symptoms&#44; Medical Encounter&#44; and Initiation of Disease Modifying Antirheumatic Drugs in Patients With Rheumatoid Arthritis"
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            "entidad" => "Unidad de Investigaci&#243;n Cl&#237;nica y Epidemiolog&#237;a&#44; Hospital General Regional N&#46;&#176; 20&#44; Instituto Mexicano del Seguro Social&#44; Tijuana&#44; Baja California&#44; Mexico"
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        "titulo" => "Tiempo entre comienzo de s&#237;ntomas&#44; acudir al m&#233;dico e inicio de f&#225;rmacos modificadores de la enfermedad en pacientes con artritis reumatoide"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Rheumatoid arthritis &#40;RA&#41; is an autoimmune disease and most patients have a chronic&#44; fluctuating progression&#46; If untreated&#44; it leads to progressive joint deformity&#44; disability and premature death&#46; The onset of early treatment with disease modifying drugs &#40;DMARD&#41; reduces disability at 5 years&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The objective of treatment in patients with recent onset RA is the suppression of disease activity before joint damage is established&#59; this justifies the importance of opportune therapeutic intervention&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> Patients treated early &#40;during the first three months since disease onset&#41; have a better prognosis and may go into disease remission&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Studies performed to evaluate time between disease onset and time of diagnosis and start of adequate treatment are scarce<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;9</span></a> and none exist in Mexico&#46; The objective of the study was to evaluate the time since the beginning of disease and the visit to the family physician&#44; the time since this and the referral to the rheumatologist and the time to onset of DMARD treatment&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We included&#44; from January to December 2010&#44; adult patients with clinical manifestations of RA and no previous evaluation by a rheumatologist or DMARD treatment&#46; Patients were sent to different family physicians or from the internal medicine specialist to the rheumatologist of a regional General Hospital of the Instituto Mexicano Seguro Social &#40;IMSS&#41;&#46; We defined RA based on the 1987 criteria proposed by the American College of Rheumatology&#46; We evaluated the following timelines&#58; time from onset of symptoms to the visit to the family physician&#59; time from disease onset to the first visit to the rheumatologist and time since disease onset and DMARD treatment onset&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Mean age&#177;SD of the 98 patients was 38&#177;9 years&#59; 85&#37; were female&#59; 49 had an RA disease progression of 1&#8211;6 months&#44; the diagnosis established by the family physician was RA in 79&#37; of patients and the mean number&#177;SD of visits the patient received before referral to rheumatology was 6&#46;6&#177;5&#46;8&#41;&#46; In 19&#44; 33&#44; 23 and 24&#37; of patients&#44; the onset of DMARD treatment was 1&#8211;3&#44; 4&#8211;6&#44; 7&#8211;12 and &#8805;13 months after RA symptom onset&#44; respectively&#46; The mean time for the patient to receive medical attention was 2&#46;9 months&#44; and for referral to Rheumatology from primary care was 6&#46;6 months&#46; For DMARD treatment onset it was 9&#46;9 months&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Our results show that only in 19&#37; of patients was DMARD started in the first three months after disease onset and the delay in the prescription of DMARD was mainly due to the delay in referral from family medicine to the rheumatologist&#46; Studies performed in the past 2 decades which evaluate the onset of DMARD treatment in patients with early RA&#44; performed in the US&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Spain&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Canada&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> the United Kingdom&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> the Middle East&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and in European countries&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> show that the mean time since the onset of disease and the onset of DMARD treatment ranges from 6 to 18 months&#44; similar to our findings &#40;mean 11 months&#41;&#46; This indicates that the diagnosis of RA after the onset of symptoms is delayed and&#44; therefore&#44; the objective of starting treatment early is not achieved in most cases&#46; Less than 30&#37; of RA patients receive DMARD treatment in the first 3 months&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;9&#44;10</span></a> It is necessary to implement measures that act on early diagnosis and treatment of RA&#44; through the diffusion of knowledge relating to the disease in the general population&#44; advertising campaigns as well as an increase in the level of knowledge regarding RA in primary care physicians&#46;</p></span>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Zonana Nacach A&#44; Campa&#241;a-Parra A&#44; Santana-Sahag&#250;n JE&#46; Tiempo entre comienzo de s&#237;ntomas&#44; acudir al m&#233;dico e inicio de f&#225;rmacos modificadores de la enfermedad en pacientes con artritis reumatoide&#46; Reumatol Clin&#46; 2014&#59;10&#58;131&#8211;132&#46;</p>"
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Article information
ISSN: 21735743
Original language: English
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Idiomas
Reumatología Clínica (English Edition)
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¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?