Alvarez-Hernández Everardo, Vázquez-Mellado Janitzia, Casasola-Vargas Julio C, Moctezuma-Ríos Jose F, García-García Conrado, Medrano-Ramírez Gabriel, Lino-Pérez Leticia, Servín Alejandra, Codina Helga, Burgos-Vargas Rubén
Rheumatology Department, Hospital General de México, Universidad Nacional Autónoma de México, Faculty of Medicine, México.
J Clin Rheumatol. 2008 Jun;14(3):148-52. doi: 10.1097/RHU.0b013e31817738bd.
To explore the extent and characteristics of glucocorticoid use by patients before attending a Mexican Rheumatology Department.
This is a cross-sectional study of 1000 consecutive first-time adults admitted to the outpatient clinic in a period of 6 months. Data were collected through a self-administered questionnaire, physician interviews, and prescription notes.
Four hundred and sixty-one (58%) of 800 questionnaires analyzed reported glucocorticoid use: 73% of them were continuous users; 63% received long and 36% medium biologic half life compounds; and each patient received a median of 2 glucocorticoids (range, 1-42). The median daily, maximum, and cumulated doses--equivalent to prednisone--were 5 mg (0.7-70 mg), 6 mg (1.1-1250 mg), and 513 mg (5-151,209 mg); 46% of the patients received oral and 22% intramuscular compounds. General physicians and nonrheumatologist specialists produced 55% and 20% of the initial prescriptions. Although, the percentage of glucocorticoid users was higher among patients with inflammatory conditions (odds ratio 4.2, 95% confidence intervals 3.06-5.85), up to 44% of patients with noninflammatory diseases also received glucocorticoids. Ninety-one (20%) patients had gross adverse events.
Before their first visit to a specialized department, nearly two-thirds of rheumatologic patients had taken glucocorticoids, which in most cases resulted from inappropriate prescription or recommendations by general physicians, nonrheumatologist specialists, and lay people.
