The use of glucocorticoids by rheumatologic patients before attending a specialized department in México.
OBJECTIVE
To explore the extent and characteristics of glucocorticoid use by patients before attending a Mexican Rheumatology Department.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Rheumatology Department, Hospital General de México, Universidad Nacional Autónoma de México, Faculty of Medicine, México.
Everardo
E
Alvarez-Hernández
Janitzia
J
Vázquez-Mellado
Julio C
JC
Casasola-Vargas
Jose F
JF
Moctezuma-Ríos
Conrado
C
García-García
Gabriel
G
Medrano-Ramírez
Leticia
L
Lino-Pérez
Alejandra
A
Servín
Helga
H
Codina
Rubén
R
Burgos-Vargas
D000328:Adult; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006306:Health Surveys; D006801:Humans; D008297:Male; D008800:Mexico; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012216:Rheumatic Diseases / Q000188:drug therapy*; D012646:Self Administration; D012651:Self Medication
D005938:Glucocorticoids