Center for Inflammatory Bowel Diseases, UCLA Health System, Los Angeles, CA, USA.
J Crohns Colitis. 2012 Feb;6 Suppl 2:S224-34. doi: 10.1016/S1873-9946(12)60502-9.
Crohn's disease is a destructive, inflammatory condition. The recent IMPACT survey showed that it has a major impact on quality of life including fatigue, relationships and employment. Although patients are generally satisfied with healthcare services, improvements are needed in the timeliness of diagnosis and in communication between patients and healthcare professionals. Evidence is lacking about what constitutes quality of care and value to patients. Moving forward, value should become the primary goal of healthcare delivery, which is likely to require new treatment goals. Indeed, goals are already evolving beyond symptom control towards deep remission, which encompasses clinical remission together with mucosal healing. The ultimate goals are to prevent bowel damage, reduce long-term disability and maintain normal quality of life. A new treat-to-target approach, with increased monitoring and tighter control of symptoms and inflammation, will be needed. This approach will be enabled by use of biomarkers and new indices such as the Lémann score, which assesses the extent and severity of bowel damage at a specific time-point and over time, and a new disability index for patients with inflammatory bowel disease. These principles have been adopted for managing rheumatoid arthritis where there is now a focus on treat-to-target to achieve early remission. Lessons from rheumatoid arthritis can be translated to Crohn's disease.
克罗恩病是一种具有破坏性和炎症性的疾病。最近的 IMPACT 调查显示,它对生活质量有重大影响,包括疲劳、人际关系和就业。尽管患者对医疗保健服务普遍满意,但在诊断的及时性以及患者与医疗保健专业人员之间的沟通方面仍需要改进。关于什么是护理质量以及对患者的价值,目前还缺乏证据。展望未来,价值应该成为医疗保健提供的主要目标,这可能需要新的治疗目标。事实上,目标已经从症状控制演变为深度缓解,包括临床缓解和黏膜愈合。最终目标是预防肠道损伤,减少长期残疾并维持正常的生活质量。需要采用一种新的针对目标的治疗方法,增加对症状和炎症的监测和更严格的控制。这种方法将通过使用生物标志物和新的指标来实现,例如 Lémann 评分,该评分可在特定时间点和随时间评估肠道损伤的程度和严重程度,以及用于炎症性肠病患者的新残疾指数。这些原则已被用于治疗类风湿关节炎,目前的重点是针对目标进行治疗以实现早期缓解。从类风湿关节炎中获得的经验教训可以转化为克罗恩病。