Department of Medicine, University of Western Ontario, London, Ontario, Canada.
J Rheumatol. 2012 Mar;39(3):524-31. doi: 10.3899/jrheum.110121. Epub 2012 Jan 15.
We determined congruence with published guidelines from the European League Against Rheumatism (EULAR)/EULAR Scleroderma Trials and Research group, for systemic sclerosis (SSc) investigations and treatment practices within the Canadian Scleroderma Research Group (CSRG).
Investigations and medication use for SSc complications were obtained from records of patients with SSc in the CSRG to determine adherence to guidelines for patients enrolled before and after the guidelines were published.
The CSRG database of 1253 patients had 992 patients with SSc enrolled before publication of the guidelines and 261 after. For pulmonary arterial hypertension (PAH) treatment, there were no differences in use before and after the guidelines, yet annual echocardiograms for PAH screening were done in 95% of patients enrolled before the guidelines and in only 86% of those enrolled after (p <0.0001), and fewer followup echocardiograms were done 1 year later in the latter group (88% vs 59%). No differences were found for the frequency of PAH-specific treatment; 60% had ever used calcium channel blockers for Raynaud's phenomenon, with no differences in the groups before and after the guidelines. But the use of phosphodiesterase type 5 inhibitors (which does not have guidelines) was increased in the after-guidelines group. Proton pump inhibitors were used in > 80% with gastroesophageal reflux disease before and after the guidelines. One-quarter with gastrointestinal symptoms were taking prokinetic drugs. For those with past SSc renal crisis, use of angiotensin-converting enzyme inhibitors was not different before and after the guidelines. For early diffuse SSc < 2 years, ever-use of methotrexate was similar (one-quarter of each group); and for symptomatic interstitial lung disease, 19% had ever used cyclophosphamide before the guidelines and 9% after (p = nonsignificant). CSRG practices were generally comparable to recently published guidelines; however, use of iloprost and bosentan was low for digital ulcers because these drugs are not approved for use in Canada.
There did not seem to be an increase in adherence to recommendations once the guidelines were published. For many guidelines, 25% to 40% of patients who would qualify received the recommended treatment.
我们确定了与欧洲抗风湿病联盟（EULAR）/EULAR 硬皮病试验和研究组发布的指南的一致性，这些指南适用于加拿大硬皮病研究组（CSRG）内的系统性硬化症（SSc）调查和治疗实践。
从 CSRG 中 SSc 患者的记录中获取 SSc 并发症的调查和药物使用情况，以确定在指南发布前后纳入的患者对指南的遵守情况。
CSRG 数据库中有 1253 名患者，其中 992 名 SSc 患者在指南发布前纳入，261 名患者在指南发布后纳入。对于肺动脉高压（PAH）治疗，指南发布前后的使用情况没有差异，但指南发布前，95%的患者接受了 PAH 筛查的年度超声心动图检查，而指南发布后，这一比例仅为 86%（p<0.0001），且后者组在 1 年后进行的随访超声心动图检查更少（88% vs 59%）。PAH 特异性治疗的频率也没有差异；60%的患者曾使用钙通道阻滞剂治疗雷诺现象，指南发布前后两组之间没有差异。但在后一组中，磷酸二酯酶 5 抑制剂（无指南）的使用增加。质子泵抑制剂用于治疗胃食管反流病，在指南发布前后均超过 80%。有四分之一的胃肠道症状患者服用促动力药物。对于有既往 SSc 肾危象的患者，指南发布前后使用血管紧张素转换酶抑制剂没有差异。对于早期弥漫性 SSc<2 年的患者，曾使用甲氨蝶呤的比例相似（每组各四分之一）；对于有症状的间质性肺病，指南发布前有 19%的患者曾使用环磷酰胺，而发布后有 9%的患者曾使用（p 无统计学意义）。CSRG 的实践与最近发布的指南大致一致；然而，由于这些药物在加拿大未获得批准使用，因此对于手指溃疡，伊洛前列素和波生坦的使用率较低。
指南发布后，对建议的遵守似乎没有增加。对于许多指南，有 25%至 40%符合条件的患者接受了推荐的治疗。
