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      Prevalence of rheumatic and musculoskeletal diseases and their impact on health-related quality of life, physical function and mental health in Portugal: results from EpiReumaPt– a national health survey


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          To estimate the national prevalence of rheumatic and musculoskeletal diseases (RMDs) in the adult Portuguese population and to determine their impact on health-related quality of life (HRQoL), physical function, anxiety and depression.


          EpiReumaPt is a national health survey with a three-stage approach. First, 10 661 adult participants were randomly selected. Trained interviewers undertook structured face-to-face questionnaires that included screening for RMDs and assessments of health-related quality of life, physical function, anxiety and depression. Second, positive screenings for ≥1 RMD plus 20% negative screenings were invited to be evaluated by a rheumatologist. Finally, three rheumatologists revised all the information and confirmed the diagnoses according to validated criteria. Estimates were computed as weighted proportions, taking the sampling design into account.


          The disease-specific prevalence rates (and 95% CIs) of RMDs in the adult Portuguese population were: low back pain, 26.4% (23.3% to 29.5%); periarticular disease, 15.8% (13.5% to 18.0%); knee osteoarthritis (OA), 12.4% (11.0% to 13.8%); osteoporosis, 10.2% (9.0% to 11.3%); hand OA, 8.7% (7.5% to 9.9%); hip OA, 2.9% (2.3% to 3.6%); fibromyalgia, 1.7% (1.1% to 2.1%); spondyloarthritis, 1.6% (1.2% to 2.1%); gout, 1.3% (1.0% to 1.6%); rheumatoid arthritis, 0.7% (0.5% to 0.9%); systemic lupus erythaematosus, 0.1% (0.1% to 0.2%) and polymyalgia rheumatica, 0.1% (0.0% to 0.2%). After multivariable adjustment, participants with RMDs had significantly lower EQ5D scores (β=−0.09; p<0.001) and higher HAQ scores (β=0.13; p<0.001) than participants without RMDs. RMDs were also significantly associated with the presence of anxiety symptoms (OR=3.5; p=0.006).


          RMDs are highly prevalent in Portugal and are associated not only with significant physical function and mental health impairment but also with poor HRQoL, leading to more health resource consumption. The EpiReumaPt study emphasises the burden of RMDs in Portugal and the need to increase RMD awareness, being a strong argument to encourage policymakers to increase the amount of resources allocated to the treatment of rheumatic patients.

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          Most cited references53

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          Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus.

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            The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study.

            To estimate the global burden of hip and knee osteoarthritis (OA) as part of the Global Burden of Disease 2010 study and to explore how the burden of hip and knee OA compares with other conditions. Systematic reviews were conducted to source age-specific and sex-specific epidemiological data for hip and knee OA prevalence, incidence and mortality risk. The prevalence and incidence of symptomatic, radiographic and self-reported hip or knee OA were included. Three levels of severity were defined to derive disability weights (DWs) and severity distribution (proportion with mild, moderate and severe OA). The prevalence by country and region was multiplied by the severity distribution and the appropriate disability weight to calculate years of life lived with disability (YLDs). As there are no deaths directly attributed to OA, YLDs equate disability-adjusted life years (DALYs). Globally, of the 291 conditions, hip and knee OA was ranked as the 11th highest contributor to global disability and 38th highest in DALYs. The global age-standardised prevalence of knee OA was 3.8% (95% uncertainty interval (UI) 3.6% to 4.1%) and hip OA was 0.85% (95% UI 0.74% to 1.02%), with no discernible change from 1990 to 2010. Prevalence was higher in females than males. YLDs for hip and knee OA increased from 10.5 million in 1990 (0.42% of total DALYs) to 17.1 million in 2010 (0.69% of total DALYs). Hip and knee OA is one of the leading causes of global disability. Methodological issues within this study make it highly likely that the real burden of OA has been underestimated. With the aging and increasing obesity of the world's population, health professions need to prepare for a large increase in the demand for health services to treat hip and knee OA. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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              2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative.

              The 1987 American College of Rheumatology (ACR; formerly the American Rheumatism Association) classification criteria for rheumatoid arthritis (RA) have been criticised for their lack of sensitivity in early disease. This work was undertaken to develop new classification criteria for RA. A joint working group from the ACR and the European League Against Rheumatism developed, in three phases, a new approach to classifying RA. The work focused on identifying, among patients newly presenting with undifferentiated inflammatory synovitis, factors that best discriminated between those who were and those who were not at high risk for persistent and/or erosive disease--this being the appropriate current paradigm underlying the disease construct 'RA'. In the new criteria set, classification as 'definite RA' is based on the confirmed presence of synovitis in at least one joint, absence of an alternative diagnosis better explaining the synovitis, and achievement of a total score of 6 or greater (of a possible 10) from the individual scores in four domains: number and site of involved joints (range 0-5), serological abnormality (range 0-3), elevated acute-phase response (range 0-1) and symptom duration (two levels; range 0-1). This new classification system redefines the current paradigm of RA by focusing on features at earlier stages of disease that are associated with persistent and/or erosive disease, rather than defining the disease by its late-stage features. This will refocus attention on the important need for earlier diagnosis and institution of effective disease-suppressing therapy to prevent or minimise the occurrence of the undesirable sequelae that currently comprise the paradigm underlying the disease construct 'RA'.

                Author and article information

                RMD Open
                RMD Open
                RMD Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                19 January 2016
                : 2
                : 1
                [1 ]EpiReumaPt Study Group—Sociedade Portuguesa de Reumatologia, Lisboa, Portugal
                [2 ]Serviço de Reumatologia do Hospital Egas Moniz—Centro Hospitalar Lisboa Ocidental (CHLO-EPE) , Lisboa, Portugal
                [3 ]Centro de Estudos de Doenças Crónicas (CEDOC) da NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL) , Lisboa, Portugal
                [4 ]EpiDoc Unit—Unidade de Epidemiologia em Doenças Crónicas (CEDOC, NMS/UNL), Lisboa, Portugal
                [5 ]Programa Nacional Contra as Doenças Reumáticas (2006–2014), Direcção Geral da Saúde , Lisboa, Portugal
                [6 ]Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular , Lisboa, Portugal
                [7 ]Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
                [8 ]Sociedade Portuguesa de Reumatologia , Lisboa, Portugal
                [9 ]Leiden University Medical Center , Leiden, The Netherlands
                [10 ]Clínica Universitária de Reumatologia, Faculdade de Medicina da Universidade de Coimbra , Coimbra, Portugal
                [11 ]Centre for Rheumatology Research & MRC Centre for Neuromuscular Diseases, University College London , London, UK
                [12 ]Centro de Estudos e Sondagens de Opinião da Universidade Católica Portuguesa (CESOP-CATÓLICA) , Lisboa, Portugal
                [13 ]Instituto de Microbiologia, Faculdade de Medicina da Universidade de Lisboa , Lisboa, Portugal
                [14 ]Unidade Curricular Especialidades Médico-Cirúrgicas I, NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL) , Lisboa, Portugal
                [15 ]Instituto Piaget , Lisboa, Portugal
                [16 ]Unidade de Epidemiologia do Instituto de Medicina Preventiva e Saúde Pública da Faculdade de Medicina da Universidade de Lisboa , Lisboa, Portugal
                [17 ]NOVA IMS, Universidade Nova de Lisboa , Lisboa, Portugal
                [18 ]Hospital Garcia de Orta , Almada, Portugal
                [19 ]Hospital Garcia de Orta, EPE , Almada, Portugal
                [20 ]APOROS—Associação Nacional contra a Osteoporose , Lisboa, Portugal
                [21 ]Instituto de Salud Musculoesquelética , Madrid, Spain
                [22 ]Serviço de Reumatologia do Hospital de Santa Maria, Centro Hospitalar Lisboa Norte (CHLN-EPE) , Lisboa, Portugal
                Author notes
                [Correspondence to ] Dr Ana Rodrigues; anamfrodrigues@ 123456gmail.com
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                Original article

                epidemiology,low back pain,fibromyalgis/pain syndromes,osteoarthritis,spondyloarthritis


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