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.
Alvarez-Hernández
Everardo
E
Rheumatology Department, Hospital General de México, Universidad Nacional Autónoma de México, Faculty of Medicine, México.
Vázquez-Mellado
Janitzia
J
Casasola-Vargas
Julio C
JC
Moctezuma-Ríos
Jose F
JF
García-García
Conrado
C
Medrano-Ramírez
Gabriel
G
Lino-Pérez
Leticia
L
Servín
Alejandra
A
Codina
Helga
H
Burgos-Vargas
Rubén
R
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