Rheumatoid arthritis seems to have DMARD treatment decision influenced by fibromyalgia
To compare DMARD use in patients with and without FM over time, including overtreatment and undertreatment rates in both groups. A prospective cohort study with patients attending an RA outpatient clinic was conducted. Participants were consecutively recruited between March 2006 and June 2007 and we...
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| Veröffentlicht in: | Revista Brasileira de Reumatologia 2017-09, Vol.57 (5), p.403-411 |
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| creator | Chakr, Rafael Mendonça da Silva Brenol, Claiton Ranzolin, Aline Bernardes, Amanda Dalosto, Ana Paula Ferrari, Giovani Scalco, Stephanie Olszewski, Vanessa Kohem, Charles Monticielo, Odirlei Brenol, João Carlos T. Xavier, Ricardo M. |
| description | To compare DMARD use in patients with and without FM over time, including overtreatment and undertreatment rates in both groups.
A prospective cohort study with patients attending an RA outpatient clinic was conducted. Participants were consecutively recruited between March 2006 and June 2007 and were followed through December 2013. Data on DMARD use (prevalences, doses and escalation rates), DAS28, HAQ and radiographic progression were compared among RA patients with FM and without FM. Mistreatment clinical scenarios were allegedly identified and compared between groups.
256 RA patients (32 with FM) were followed for 6.2±2.0 (mean±SD) years comprising 2986 visits. At baseline, RA duration was 11.1±7.4 years. DAS28 and HAQ were greater in RA with FM group, and were closer to RA without FM group towards the end. RA patients with FM used higher doses of tricyclic antidepressants, leflunomide and prednisone, and lower doses of methotrexate. When compared to RA patients without FM, participants with RA and FM used more often tricyclic antidepressants, leflunomide, prednisone, continuous analgesics and less often methotrexate. Groups presented similar 7-year biologic-free survival, and radiographic progression-free survival in Cox regression. RA patients with FM had greater proportions of visits in mistreatment scenarios when compared to RA patients without FM (28.4 vs. 19.8%, p |
| doi_str_mv | 10.1016/j.rbre.2017.01.004 |
| format | Article |
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A prospective cohort study with patients attending an RA outpatient clinic was conducted. Participants were consecutively recruited between March 2006 and June 2007 and were followed through December 2013. Data on DMARD use (prevalences, doses and escalation rates), DAS28, HAQ and radiographic progression were compared among RA patients with FM and without FM. Mistreatment clinical scenarios were allegedly identified and compared between groups.
256 RA patients (32 with FM) were followed for 6.2±2.0 (mean±SD) years comprising 2986 visits. At baseline, RA duration was 11.1±7.4 years. DAS28 and HAQ were greater in RA with FM group, and were closer to RA without FM group towards the end. RA patients with FM used higher doses of tricyclic antidepressants, leflunomide and prednisone, and lower doses of methotrexate. When compared to RA patients without FM, participants with RA and FM used more often tricyclic antidepressants, leflunomide, prednisone, continuous analgesics and less often methotrexate. Groups presented similar 7-year biologic-free survival, and radiographic progression-free survival in Cox regression. RA patients with FM had greater proportions of visits in mistreatment scenarios when compared to RA patients without FM (28.4 vs. 19.8%, p<0.001).
RA patients with FM used more leflunomide and prednisone, and RA mistreatment was more frequent in FM patients. Certainly, RA patients with FM will benefit from a personalized T2T strategy, including ultrasound (when suitable) and proper FM treatment.
Comparar o uso de fármacos antirreumáticos modificadores da doença (DMARD) em pacientes com e sem fibromialgia (FM) ao longo do tempo, incluindo as taxas de tratamento excessivo e subtratamento em ambos os grupos.
Estudo de coorte prospectiva com pacientes atendidos em um ambulatório de artrite reumatoide (AR). Os participantes foram recrutados consecutivamente entre março de 2006 e junho de 2007 e foram seguidos até dezembro de 2013. Compararam-se os dados de uso de DMARD (prevalências, doses e taxas de escalonamento), 28-Joint Disease Activity Score (DAS28), Health Assessment Questionnaire (HAQ) e progressão radiográfica entre pacientes com e sem FM. Os cenários clínicos de tratamento supostamente incorreto foram identificados e comparados entre os grupos.
Seguiram-se 256 pacientes com AR (32 com FM) por 6,2±2,0 (média±DP) anos, período que abrangeu 2.986 consultas. No início do estudo, a duração da AR era de 11,1±7,4 anos. O DAS28 e o HAQ foram maiores no grupo AR com FM e estavam mais próximos do grupo AR sem FM no fim do estudo. Os pacientes com AR com FM usaram doses mais altas de antidepressivos tricíclicos, leflunomida e prednisona e doses mais baixas de metotrexato. Quando comparados com os pacientes com AR sem FM, os participantes com AR e FM usaram mais frequentemente antidepressivos tricíclicos, leflunomida, prednisona e analgésicos contínuos e menos frequentemente metotrexato. Os grupos apresentaram sobrevida em sete anos sem agentes biológicos e livres de progressão radiográfica semelhantes na regressão Cox. Os pacientes com AR com FM apresentaram uma maior proporção de consultas em cenários de tratamento supostamente incorreto quando comparados com os pacientes com AR sem FM (28,4 vs. 19,8%, p<0,001).
Os pacientes com AR e FM usaram mais leflunomida e prednisona e o tratamento supostamente incorreto na AR foi mais frequente em pacientes com FM. Os pacientes com AR com FM certamente se beneficiarão de uma estratégia personalizada de tratamento por metas (T2T), incluindo ultrassonografia (quando apropriado) e controle da FM.</description><identifier>ISSN: 2255-5021</identifier><identifier>ISSN: 1809-4570</identifier><identifier>EISSN: 2255-5021</identifier><identifier>DOI: 10.1016/j.rbre.2017.01.004</identifier><identifier>PMID: 29037312</identifier><language>eng</language><publisher>Brazil: Elsevier Editora Ltda</publisher><subject>Adult ; Aged ; Antirheumatic Agents - therapeutic use ; Arthritis, Rheumatoid - complications ; Arthritis, Rheumatoid - drug therapy ; Artrite reumatoide ; Brazil ; Case-Control Studies ; Clinical Decision-Making ; Disease Progression ; Drug Administration Schedule ; Drug therapy ; Female ; Fibromialgia ; Fibromyalgia ; Fibromyalgia - complications ; Follow-Up Studies ; Humans ; Inappropriate Prescribing - statistics & numerical data ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Practice Patterns, Physicians' - statistics & numerical data ; Proportional Hazards Models ; Prospective Studies ; Rheumatoid arthritis ; Severity of Illness Index ; Tratamento farmacológico</subject><ispartof>Revista Brasileira de Reumatologia, 2017-09, Vol.57 (5), p.403-411</ispartof><rights>2017 Elsevier Editora Ltda.</rights><rights>Copyright © 2017 Elsevier Editora Ltda. All rights reserved.</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c435t-b33c98582670806f9f90303576513f3efc90a1225853c885c6f69149ff1a9c523</citedby><cites>FETCH-LOGICAL-c435t-b33c98582670806f9f90303576513f3efc90a1225853c885c6f69149ff1a9c523</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29037312$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chakr, Rafael Mendonça da Silva</creatorcontrib><creatorcontrib>Brenol, Claiton</creatorcontrib><creatorcontrib>Ranzolin, Aline</creatorcontrib><creatorcontrib>Bernardes, Amanda</creatorcontrib><creatorcontrib>Dalosto, Ana Paula</creatorcontrib><creatorcontrib>Ferrari, Giovani</creatorcontrib><creatorcontrib>Scalco, Stephanie</creatorcontrib><creatorcontrib>Olszewski, Vanessa</creatorcontrib><creatorcontrib>Kohem, Charles</creatorcontrib><creatorcontrib>Monticielo, Odirlei</creatorcontrib><creatorcontrib>Brenol, João Carlos T.</creatorcontrib><creatorcontrib>Xavier, Ricardo M.</creatorcontrib><title>Rheumatoid arthritis seems to have DMARD treatment decision influenced by fibromyalgia</title><title>Revista Brasileira de Reumatologia</title><addtitle>Rev Bras Reumatol Engl Ed</addtitle><description>To compare DMARD use in patients with and without FM over time, including overtreatment and undertreatment rates in both groups.
A prospective cohort study with patients attending an RA outpatient clinic was conducted. Participants were consecutively recruited between March 2006 and June 2007 and were followed through December 2013. Data on DMARD use (prevalences, doses and escalation rates), DAS28, HAQ and radiographic progression were compared among RA patients with FM and without FM. Mistreatment clinical scenarios were allegedly identified and compared between groups.
256 RA patients (32 with FM) were followed for 6.2±2.0 (mean±SD) years comprising 2986 visits. At baseline, RA duration was 11.1±7.4 years. DAS28 and HAQ were greater in RA with FM group, and were closer to RA without FM group towards the end. RA patients with FM used higher doses of tricyclic antidepressants, leflunomide and prednisone, and lower doses of methotrexate. When compared to RA patients without FM, participants with RA and FM used more often tricyclic antidepressants, leflunomide, prednisone, continuous analgesics and less often methotrexate. Groups presented similar 7-year biologic-free survival, and radiographic progression-free survival in Cox regression. RA patients with FM had greater proportions of visits in mistreatment scenarios when compared to RA patients without FM (28.4 vs. 19.8%, p<0.001).
RA patients with FM used more leflunomide and prednisone, and RA mistreatment was more frequent in FM patients. Certainly, RA patients with FM will benefit from a personalized T2T strategy, including ultrasound (when suitable) and proper FM treatment.
Comparar o uso de fármacos antirreumáticos modificadores da doença (DMARD) em pacientes com e sem fibromialgia (FM) ao longo do tempo, incluindo as taxas de tratamento excessivo e subtratamento em ambos os grupos.
Estudo de coorte prospectiva com pacientes atendidos em um ambulatório de artrite reumatoide (AR). Os participantes foram recrutados consecutivamente entre março de 2006 e junho de 2007 e foram seguidos até dezembro de 2013. Compararam-se os dados de uso de DMARD (prevalências, doses e taxas de escalonamento), 28-Joint Disease Activity Score (DAS28), Health Assessment Questionnaire (HAQ) e progressão radiográfica entre pacientes com e sem FM. Os cenários clínicos de tratamento supostamente incorreto foram identificados e comparados entre os grupos.
Seguiram-se 256 pacientes com AR (32 com FM) por 6,2±2,0 (média±DP) anos, período que abrangeu 2.986 consultas. No início do estudo, a duração da AR era de 11,1±7,4 anos. O DAS28 e o HAQ foram maiores no grupo AR com FM e estavam mais próximos do grupo AR sem FM no fim do estudo. Os pacientes com AR com FM usaram doses mais altas de antidepressivos tricíclicos, leflunomida e prednisona e doses mais baixas de metotrexato. Quando comparados com os pacientes com AR sem FM, os participantes com AR e FM usaram mais frequentemente antidepressivos tricíclicos, leflunomida, prednisona e analgésicos contínuos e menos frequentemente metotrexato. Os grupos apresentaram sobrevida em sete anos sem agentes biológicos e livres de progressão radiográfica semelhantes na regressão Cox. Os pacientes com AR com FM apresentaram uma maior proporção de consultas em cenários de tratamento supostamente incorreto quando comparados com os pacientes com AR sem FM (28,4 vs. 19,8%, p<0,001).
Os pacientes com AR e FM usaram mais leflunomida e prednisona e o tratamento supostamente incorreto na AR foi mais frequente em pacientes com FM. Os pacientes com AR com FM certamente se beneficiarão de uma estratégia personalizada de tratamento por metas (T2T), incluindo ultrassonografia (quando apropriado) e controle da FM.</description><subject>Adult</subject><subject>Aged</subject><subject>Antirheumatic Agents - therapeutic use</subject><subject>Arthritis, Rheumatoid - complications</subject><subject>Arthritis, Rheumatoid - drug therapy</subject><subject>Artrite reumatoide</subject><subject>Brazil</subject><subject>Case-Control Studies</subject><subject>Clinical Decision-Making</subject><subject>Disease Progression</subject><subject>Drug Administration Schedule</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Fibromialgia</subject><subject>Fibromyalgia</subject><subject>Fibromyalgia - complications</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Inappropriate Prescribing - statistics & numerical data</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Practice Patterns, Physicians' - statistics & numerical data</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Rheumatoid arthritis</subject><subject>Severity of Illness Index</subject><subject>Tratamento farmacológico</subject><issn>2255-5021</issn><issn>1809-4570</issn><issn>2255-5021</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>DOA</sourceid><recordid>eNp9kU1r3DAQhkVpaUKaP9BD0bGXdUdftgW9hKQfgZRCaHsVsjzKarGtVJID---rzaahp540iHeemXdeQt4yaBiw9sOuSUPChgPrGmANgHxBTjlXaqOAs5f_1CfkPOcdQFVKzgW8Jidcg-gE46fk1-0W19mWGEZqU9mmUEKmGXHOtES6tQ9Ir75d3F7RktCWGZdCR3Qhh7jQsPhpxcXhSIc99WFIcd7b6S7YN-SVt1PG86f3jPz8_OnH5dfNzfcv15cXNxsnhSqbQQine9XztoMeWq99XQyE6lrFhBfonQbLqpNeCdf3yrW-1Uxq75nVTnFxRq6P3DHanblPYbZpb6IN5vEjpjtTXQU3oemElaCsbnur5aj0MEiv5eDlOAhgGivr_ZF1n-LvFXMxc8gOp8kuGNdsmFacQd91XZXyo9SlmHNC_zyagTnEY3bmEI85xGOAmRpPbXr3xF-HGcfnlr9hVMHHowDrxR4CJpNdeDxvSOhKtRT-x_8DPrKe1g</recordid><startdate>20170901</startdate><enddate>20170901</enddate><creator>Chakr, Rafael Mendonça da Silva</creator><creator>Brenol, Claiton</creator><creator>Ranzolin, Aline</creator><creator>Bernardes, Amanda</creator><creator>Dalosto, Ana Paula</creator><creator>Ferrari, Giovani</creator><creator>Scalco, Stephanie</creator><creator>Olszewski, Vanessa</creator><creator>Kohem, Charles</creator><creator>Monticielo, Odirlei</creator><creator>Brenol, João Carlos T.</creator><creator>Xavier, Ricardo M.</creator><general>Elsevier Editora Ltda</general><general>Sociedade Brasileira de Reumatologia</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>DOA</scope></search><sort><creationdate>20170901</creationdate><title>Rheumatoid arthritis seems to have DMARD treatment decision influenced by fibromyalgia</title><author>Chakr, Rafael Mendonça da Silva ; Brenol, Claiton ; Ranzolin, Aline ; Bernardes, Amanda ; Dalosto, Ana Paula ; Ferrari, Giovani ; Scalco, Stephanie ; Olszewski, Vanessa ; Kohem, Charles ; Monticielo, Odirlei ; Brenol, João Carlos T. ; Xavier, Ricardo M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c435t-b33c98582670806f9f90303576513f3efc90a1225853c885c6f69149ff1a9c523</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Antirheumatic Agents - therapeutic use</topic><topic>Arthritis, Rheumatoid - complications</topic><topic>Arthritis, Rheumatoid - drug therapy</topic><topic>Artrite reumatoide</topic><topic>Brazil</topic><topic>Case-Control Studies</topic><topic>Clinical Decision-Making</topic><topic>Disease Progression</topic><topic>Drug Administration Schedule</topic><topic>Drug therapy</topic><topic>Female</topic><topic>Fibromialgia</topic><topic>Fibromyalgia</topic><topic>Fibromyalgia - complications</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Inappropriate Prescribing - statistics & numerical data</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Practice Patterns, Physicians' - statistics & numerical data</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><topic>Rheumatoid arthritis</topic><topic>Severity of Illness Index</topic><topic>Tratamento farmacológico</topic><toplevel>online_resources</toplevel><creatorcontrib>Chakr, Rafael Mendonça da Silva</creatorcontrib><creatorcontrib>Brenol, Claiton</creatorcontrib><creatorcontrib>Ranzolin, Aline</creatorcontrib><creatorcontrib>Bernardes, Amanda</creatorcontrib><creatorcontrib>Dalosto, Ana Paula</creatorcontrib><creatorcontrib>Ferrari, Giovani</creatorcontrib><creatorcontrib>Scalco, Stephanie</creatorcontrib><creatorcontrib>Olszewski, Vanessa</creatorcontrib><creatorcontrib>Kohem, Charles</creatorcontrib><creatorcontrib>Monticielo, Odirlei</creatorcontrib><creatorcontrib>Brenol, João Carlos T.</creatorcontrib><creatorcontrib>Xavier, Ricardo M.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Revista Brasileira de Reumatologia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chakr, Rafael Mendonça da Silva</au><au>Brenol, Claiton</au><au>Ranzolin, Aline</au><au>Bernardes, Amanda</au><au>Dalosto, Ana Paula</au><au>Ferrari, Giovani</au><au>Scalco, Stephanie</au><au>Olszewski, Vanessa</au><au>Kohem, Charles</au><au>Monticielo, Odirlei</au><au>Brenol, João Carlos T.</au><au>Xavier, Ricardo M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Rheumatoid arthritis seems to have DMARD treatment decision influenced by fibromyalgia</atitle><jtitle>Revista Brasileira de Reumatologia</jtitle><addtitle>Rev Bras Reumatol Engl Ed</addtitle><date>2017-09-01</date><risdate>2017</risdate><volume>57</volume><issue>5</issue><spage>403</spage><epage>411</epage><pages>403-411</pages><issn>2255-5021</issn><issn>1809-4570</issn><eissn>2255-5021</eissn><abstract>To compare DMARD use in patients with and without FM over time, including overtreatment and undertreatment rates in both groups.
A prospective cohort study with patients attending an RA outpatient clinic was conducted. Participants were consecutively recruited between March 2006 and June 2007 and were followed through December 2013. Data on DMARD use (prevalences, doses and escalation rates), DAS28, HAQ and radiographic progression were compared among RA patients with FM and without FM. Mistreatment clinical scenarios were allegedly identified and compared between groups.
256 RA patients (32 with FM) were followed for 6.2±2.0 (mean±SD) years comprising 2986 visits. At baseline, RA duration was 11.1±7.4 years. DAS28 and HAQ were greater in RA with FM group, and were closer to RA without FM group towards the end. RA patients with FM used higher doses of tricyclic antidepressants, leflunomide and prednisone, and lower doses of methotrexate. When compared to RA patients without FM, participants with RA and FM used more often tricyclic antidepressants, leflunomide, prednisone, continuous analgesics and less often methotrexate. Groups presented similar 7-year biologic-free survival, and radiographic progression-free survival in Cox regression. RA patients with FM had greater proportions of visits in mistreatment scenarios when compared to RA patients without FM (28.4 vs. 19.8%, p<0.001).
RA patients with FM used more leflunomide and prednisone, and RA mistreatment was more frequent in FM patients. Certainly, RA patients with FM will benefit from a personalized T2T strategy, including ultrasound (when suitable) and proper FM treatment.
Comparar o uso de fármacos antirreumáticos modificadores da doença (DMARD) em pacientes com e sem fibromialgia (FM) ao longo do tempo, incluindo as taxas de tratamento excessivo e subtratamento em ambos os grupos.
Estudo de coorte prospectiva com pacientes atendidos em um ambulatório de artrite reumatoide (AR). Os participantes foram recrutados consecutivamente entre março de 2006 e junho de 2007 e foram seguidos até dezembro de 2013. Compararam-se os dados de uso de DMARD (prevalências, doses e taxas de escalonamento), 28-Joint Disease Activity Score (DAS28), Health Assessment Questionnaire (HAQ) e progressão radiográfica entre pacientes com e sem FM. Os cenários clínicos de tratamento supostamente incorreto foram identificados e comparados entre os grupos.
Seguiram-se 256 pacientes com AR (32 com FM) por 6,2±2,0 (média±DP) anos, período que abrangeu 2.986 consultas. No início do estudo, a duração da AR era de 11,1±7,4 anos. O DAS28 e o HAQ foram maiores no grupo AR com FM e estavam mais próximos do grupo AR sem FM no fim do estudo. Os pacientes com AR com FM usaram doses mais altas de antidepressivos tricíclicos, leflunomida e prednisona e doses mais baixas de metotrexato. Quando comparados com os pacientes com AR sem FM, os participantes com AR e FM usaram mais frequentemente antidepressivos tricíclicos, leflunomida, prednisona e analgésicos contínuos e menos frequentemente metotrexato. Os grupos apresentaram sobrevida em sete anos sem agentes biológicos e livres de progressão radiográfica semelhantes na regressão Cox. Os pacientes com AR com FM apresentaram uma maior proporção de consultas em cenários de tratamento supostamente incorreto quando comparados com os pacientes com AR sem FM (28,4 vs. 19,8%, p<0,001).
Os pacientes com AR e FM usaram mais leflunomida e prednisona e o tratamento supostamente incorreto na AR foi mais frequente em pacientes com FM. Os pacientes com AR com FM certamente se beneficiarão de uma estratégia personalizada de tratamento por metas (T2T), incluindo ultrassonografia (quando apropriado) e controle da FM.</abstract><cop>Brazil</cop><pub>Elsevier Editora Ltda</pub><pmid>29037312</pmid><doi>10.1016/j.rbre.2017.01.004</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Alma/SFX Local Collection |
| subjects | Adult Aged Antirheumatic Agents - therapeutic use Arthritis, Rheumatoid - complications Arthritis, Rheumatoid - drug therapy Artrite reumatoide Brazil Case-Control Studies Clinical Decision-Making Disease Progression Drug Administration Schedule Drug therapy Female Fibromialgia Fibromyalgia Fibromyalgia - complications Follow-Up Studies Humans Inappropriate Prescribing - statistics & numerical data Kaplan-Meier Estimate Male Middle Aged Practice Patterns, Physicians' - statistics & numerical data Proportional Hazards Models Prospective Studies Rheumatoid arthritis Severity of Illness Index Tratamento farmacológico |
| title | Rheumatoid arthritis seems to have DMARD treatment decision influenced by fibromyalgia |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-24T21%3A47%3A28IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_doaj_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Rheumatoid%20arthritis%20seems%20to%20have%20DMARD%20treatment%20decision%20influenced%20by%20fibromyalgia&rft.jtitle=Revista%20Brasileira%20de%20Reumatologia&rft.au=Chakr,%20Rafael%20Mendon%C3%A7a%20da%20Silva&rft.date=2017-09-01&rft.volume=57&rft.issue=5&rft.spage=403&rft.epage=411&rft.pages=403-411&rft.issn=2255-5021&rft.eissn=2255-5021&rft_id=info:doi/10.1016/j.rbre.2017.01.004&rft_dat=%3Cproquest_doaj_%3E1952108777%3C/proquest_doaj_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1952108777&rft_id=info:pmid/29037312&rft_els_id=S2255502117300044&rft_doaj_id=oai_doaj_org_article_73a405a968a94d59bb4f94bf4db3019e&rfr_iscdi=true |