Department of Medicine, Division of Rheumatology, Stanford University, Palo Alto, California, USA.
Arthritis Care Res (Hoboken). 2010 Jul;62(7):993-1001. doi: 10.1002/acr.20150.
Osteoporosis and fragility fractures are associated with significant morbidity for patients with systemic lupus erythematosus (SLE). New quality indicators (QIs) for SLE advise bone mineral density testing, calcium and vitamin D use, and antiresorptive or anabolic treatment for specific subgroups of patients receiving high-dose steroids.
Subjects were participants in the University of California, San Francisco Lupus Outcomes Study, an ongoing longitudinal study of patients with physician-confirmed SLE, in 2007-2008. Patients responded to an annual telephone survey and were queried regarding demographic, clinical, and other health care-related variables. Multiple logistic regression was used to predict receipt of care per the QIs described above.
One hundred twenty-seven patients met the criteria for the formal definitions of the denominators for QI I (screening) and QI II (calcium and vitamin D); 91 met the formal criteria for QI III (treatment). The proportions of patients receiving care consistent with the QIs were 74%, 58%, and 56% for QIs I, II, and III, respectively. In a sensitivity analysis of all steroid users (n = 427 for QI I and II and n = 224 for QI III), rates were slightly lower. Predictors of receiving care varied by QI and by denominator; however, female sex, older age, white race, and longer disease duration were associated with higher-quality care.
Bone health-related care in this community-based cohort of SLE patients is suboptimal. Quality improvement efforts should address osteoporosis prevention and care among all SLE patients, especially those receiving high-dose, prolonged steroids.
骨质疏松症和脆性骨折与系统性红斑狼疮（SLE）患者的高发病率相关。新的 SLE 质量指标（QI）建议对接受大剂量类固醇治疗的特定亚组患者进行骨密度检测、钙和维生素 D 的使用以及抗吸收或合成代谢治疗。
受试者为 2007-2008 年参加加利福尼亚大学旧金山狼疮结局研究的患者，这是一项正在进行的、针对确诊为 SLE 的患者的纵向研究。患者每年接受一次电话调查，并被询问有关人口统计学、临床和其他医疗保健相关变量的问题。多变量逻辑回归用于预测符合上述 QI 的护理情况。
127 名患者符合 QI I（筛查）和 QI II（钙和维生素 D）的正式定义的分母标准；91 名患者符合 QI III（治疗）的正式标准。符合 QI 的患者接受护理的比例分别为 74%、58%和 56%，分别为 QI I、II 和 III。在对所有类固醇使用者（QI I 和 II 为 427 例，QI III 为 224 例）进行的敏感性分析中，比率略低。接受护理的预测因素因 QI 和分母而异；然而，女性、年龄较大、白种人和疾病持续时间较长与更高质量的护理相关。
在这个基于社区的 SLE 患者队列中，与骨骼健康相关的护理并不理想。质量改进工作应针对所有 SLE 患者，尤其是接受大剂量、长期类固醇治疗的患者，预防和治疗骨质疏松症。
