Pincus Theodore, Skummer Philip T, Grisanti Michael T, Castrejón Isabel, Yazici Yusuf
Division of Rheumatology, NYU Hospital for Joint Diseases, 301 East 17th Street, Room 1608, New York, New York 10003, USA.
Bull NYU Hosp Jt Dis. 2012;70(3):177-86.
The management of rheumatoid arthritis (RA) depends more on the patient history than most other chronic diseases. A patient questionnaire provides a uniform, quantitative, protocolized, "scientific" patient history, with documented prognostic significance for work disability and mortality in RA greater than radiographs and laboratory tests and capacity to distinguish active from control treatment in clinical trials and to monitor clinical care with equivalent or greater significance than joint counts or laboratory tests. Therefore, a "scientific" approach to care of a person with a rheumatic disease involves review of patient function, pain, global status, fatigue, RAPID3, review of systems, self-report joint count, and recent medical history on an MDHAQ before conversation with the patient. This practice may be viewed as analogous to a doctor reviewing blood pressure, hemoglobin A1c, viral load, or radiograph before meeting with a patient who has hypertension, diabetes, HIV, or a healing fracture to provide a roadmap or agenda for the visit. Some sites have implemented RAPID3 without the remainder of MDHAQ, a practice that is discouraged. The MDHAQ requires only 5 to 10 minutes of the patient's time and involves a single sheet of paper, which is needed for a simple RAPID3, or even a patient global estimate of status to score a DAS28 or CDAI. Completion of MDHAQ/RAPID3 by each patient at each visit in the infrastructure of care with review by the doctor helps prepare the patient for the visit, improves doctor-patient communication, saves time for the doctor, and provides a roadmap or agenda for the visit.
类风湿关节炎(RA)的管理比大多数其他慢性病更依赖于患者病史。患者问卷提供了一份统一、定量、标准化的“科学”患者病史,其对RA工作残疾和死亡率的预后意义有文献记载,比X光片和实验室检查更具意义,并且在临床试验中能够区分积极治疗与对照治疗,在监测临床护理方面与关节计数或实验室检查具有同等或更大的意义。因此,对风湿病患者进行“科学”护理的方法包括在与患者交谈之前,根据MDHAQ回顾患者功能、疼痛、整体状况、疲劳、RAPID3、系统回顾、自我报告关节计数以及近期病史。这种做法可被视为类似于医生在会见患有高血压、糖尿病、HIV或骨折正在愈合的患者之前查看血压、糖化血红蛋白A1c、病毒载量或X光片,以便为就诊提供路线图或议程。一些机构在未实施MDHAQ其余部分的情况下就实施了RAPID3,这种做法是不可取的。MDHAQ仅需患者5到10分钟时间,只需一张纸,这对于简单的RAPID3甚至患者对自身状况的总体评估以计算DAS28或CDAI评分来说是必需的。在护理过程中,每位患者每次就诊时完成MDHAQ/RAPID3并由医生进行审查,有助于患者为就诊做好准备,改善医患沟通,为医生节省时间,并为就诊提供路线图或议程。