{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T21:34:00Z","timestamp":1764884040510,"version":"3.46.0"},"reference-count":31,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T00:00:00Z","timestamp":1763683200000},"content-version":"unspecified","delay-in-days":20,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004325","name":"AstraZeneca","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004325","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,10,31]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to describe the epidemiology, outcomes and costs of four immune-mediated inflammatory rheumatic diseases (IMIRDs)\u2014systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS)\u2014in Brazil\u2019s public and private healthcare systems from 2018 to 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective observational study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The study was conducted across hospital and outpatient levels of care in Brazil, based on nationwide data representing the public (Department of Informatics of the Unified Health System\u2014DATASUS) and private (National Supplementary Health Agency\u2014ANS) healthcare sectors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>The study analysed data from four distinct systems: 609\u2009427 patients from the public Outpatient Information System (SIA), 32\u2009119 patients from the public Hospital Information System (SIH), 19\u2009083 deaths from the public Mortality Information System (SIM) and 11\u2009846 hospitalisations from the private healthcare system (ANS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>RA had the highest incidence, ranging from 19.9 to 24.9 per 100 000, while SLE remained stable (6.3\u20136.7 per 100 000). Prevalence increased for all diseases: RA rose from 95.7 to 136.8, SLE from 23.4 to 38.9, AS from 15.0 to 23.6 and PsA from 10.8 to 17.4 per 100\u2009000. SLE had the highest hospitalisation (7.2%) and lethality rates (8.7%), along with the highest average outpatient cost (US$440.9 per patient). In the private system, RA and SLE accounted for the most hospitalisations (36.3% each). SLE had the highest proportion of emergency hospitalisations (70.5%), while PsA had the highest proportion of elective hospitalisations (61.8%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>RA had the highest prevalence and incidence rates among the studied IMIRDs, while SLE was associated with the highest lethality, outpatient costs and emergency hospitalisations. The rising prevalence of these diseases highlights their growing burden on Brazil\u2019s healthcare systems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT06698900\">NCT06698900<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-104870","type":"journal-article","created":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T05:45:24Z","timestamp":1763963124000},"page":"e104870","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Current landscape of immune-mediated inflammatory rheumatic diseases in Brazil\u2019s public and private systems: retrospective cohort study"],"prefix":"10.1136","volume":"15","clinical-trial-number":[{"clinical-trial-number":"nct06698900","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Odirlei Andre","family":"Monticielo","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luciana Parente Costa","family":"Seguro","sequence":"additional","affiliation":[{"name":"Rheumatology, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henrique","family":"de Ata\u00edde Mariz","sequence":"additional","affiliation":[{"name":"Universidade Federal de Pernambuco, Recife, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0903-1296","authenticated-orcid":false,"given":"Milena","family":"Daher Macedo","sequence":"additional","affiliation":[{"name":"AstraZeneca, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1306-3980","authenticated-orcid":false,"given":"Vanessa","family":"Therumi Assao","sequence":"additional","affiliation":[{"name":"ICON Plc Brazil, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00falia","family":"Lima","sequence":"additional","affiliation":[{"name":"Oracle Life Sciences, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathalia","family":"Volpi e Silva","sequence":"additional","affiliation":[{"name":"Oracle Life Sciences, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edgard Torres","family":"Dos Reis-Neto","sequence":"additional","affiliation":[{"name":"Department of Medicine, Universidade Federal de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,11,23]]},"reference":[{"key":"2025120413271100000_15.11.e104870.1","doi-asserted-by":"publisher","DOI":"10.1038\/s41584-020-00522-w"},{"key":"2025120413271100000_15.11.e104870.2","doi-asserted-by":"publisher","DOI":"10.1038\/s41577-021-00603-1"},{"key":"2025120413271100000_15.11.e104870.3","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.091461"},{"key":"2025120413271100000_15.11.e104870.4","doi-asserted-by":"publisher","DOI":"10.1111\/1756-185X.14416"},{"key":"2025120413271100000_15.11.e104870.5","doi-asserted-by":"crossref","first-page":"1468","DOI":"10.1111\/1756-185X.13353","article-title":"Emerging role of metabolomics in rheumatology","volume":"21","author":"Gupta","year":"2018","journal-title":"Int J Rheum Dis"},{"key":"2025120413271100000_15.11.e104870.6","doi-asserted-by":"crossref","DOI":"10.11606\/s1518-8787.2022056003918","article-title":"Systemic autoimmune diseases and work outcomes in Brazil: a scoping review","volume":"56","author":"Cordeiro","year":"2022","journal-title":"Rev Saude Publica"},{"key":"2025120413271100000_15.11.e104870.7","first-page":"s120","article-title":"The health system of Brazil","volume":"53 Suppl 2","author":"Montekio","year":"2011","journal-title":"Salud Publica Mex"},{"key":"2025120413271100000_15.11.e104870.8","unstructured":"IBGE . 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