Profile of paediatric rheumatology specialists and services in the state of São Paulo.
BACKGROUND
Paediatric rheumatology (PR) is an emerging specialty, practised by a limited number of specialists. Currently, there is neither a record of the profile of rheumatology patients being treated in Brazil nor data on the training of qualified rheumatology professionals in the country.


OBJECTIVE
To investigate the profile of PR specialists and services, as well as the characteristics of paediatric patients with rheumatic diseases, for estimating the current state of rheumatology in the state of São Paulo.


METHODS
In 2010, the scientific department of PR of the Paediatric Society of São Paulo administered a questionnaire that was answered by 24/31 accredited specialists in PR practising in state of São Paulo and by 8/21 institutions that provide PR care.


RESULTS
Most (91%) of the surveyed professionals practise in public institutions. Private clinics (28.6%) and public institutions (37.5%) reported not having access to nailfold capillaroscopy, and 50% of the private clinics reported not having access to acupuncture. The average duration of professional practise in PR was 9.4 years, and 67% of the physicians had attended postgraduate programmes. Seven (87.5%) public institutions perform teaching activities, in which new paediatric rheumatologists are trained, and five (62.5%) offer postgraduate programmes. Two-thirds of the surveyed specialists use immunosuppressants and biological agents classified as "restricted use" by the Health Secretariat. The disease most frequently reported was juvenile idiopathic arthritis (29.1-34.5%), followed by juvenile systemic lupus erythematosus (JSLE) (11.6-12.3%) and rheumatic fever (9.1-15.9%). The incidence of vasculitis (including Henoch-Schönlein purpura, Wegener's granulomatosis, and Takayasu's arteritis) and autoinflammatory syndromes was higher in public institutions compared to other institutions (P = 0.03, P = 0.04, P = 0.002, and P < 0.0001, respectively). Patients with JSLE had the highest mortality rate (68% of deaths), mainly due to infection.


CONCLUSIONS
The field of PR in the state of São Paulo has a significant number of specialists with postgraduate degrees who mostly practise at teaching institutions with infrastructures appropriate for the care of high-complexity patients.
Maria Teresa
MT
Terreri
Lúcia M A
LM
Campos
Eunice M
EM
Okuda
Clovis A
CA
Silva
Silvana B
SB
Sacchetti
Roberto
R
Marini
Virginia P
VP
Ferriani
Maria Heloiza
MH
Ventura
Taciana
T
Fernandes
Juliana O
JO
Sato
Elizabeth C
EC
Fernandes
Claudio
C
Len
Cássia
C
Barbosa
Ana Paola
AP
Lotito
Maria Carolina dos
MC
Santos
Nádia E
NE
Aikawa
Mércia
M
Facó
Daniela
D
Piotto
Vanessa
V
Bugni
Kátia T
KT
Kozu
Paulo R
PR
Romanelli
Adriana M E
AM
Sallum
Marília
M
Febronio
Melissa
M
Fraga
Cláudia S
CS
Magalhães
D001938:Brazil; D002648:Child; D006801:Humans; D010372:Pediatrics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000175:diagnosis / Q000628:therapy; D012219:Rheumatology / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires