Division of Rheumatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
Pediatr Rheumatol Online J. 2013 Jan 15;11(1):3. doi: 10.1186/1546-0096-11-3.
Variations in the treatment of juvenile idiopathic arthritis (JIA) may impact on quality of care. The objective of this study was to identify and compare treatment approaches for JIA in two health care systems.
Paediatric rheumatologists in Canada (n=58) and Germany/Austria (n=172) were surveyed by email, using case-based vignettes for oligoarticular and seronegative polyarticular JIA. Data were analysed using descriptive statistics; responses were compared using univariate analysis.
Total response rate was 63%. Physicians were comparable by age, level of training and duration of practice, with more Canadians based in academic centres. For initial treatment of oligoarthritis, only approximately half of physicians in both groups used intra-articular steroids. German physicians were more likely to institute DMARD treatment in oligoarthritis refractory to NSAID (p<0.001). Canadian physicians were more likely to switch to a different DMARD rather than a biologic agent in polyarthritis refractory to initial DMARD therapy. For oligoarthritis and polyarthritis, respectively, 86% and 90% of German physicians preferred regular physiotherapy over home exercise, compared to 14% and 15% in Canada. Except for a Canadian preference for naproxen in oligoarthritis, no significant differences were found for NSAID, intra-articular steroid preparations, initial DMARD and initial biologic treatment.
Treatment of oligo- and polyarticular JIA with DMARD is mostly uniform, with availability and funding obviously influencing physician choice. Usage of intra-articular steroids is variable within physician groups. Physiotherapy has a fundamentally different role in the two health care systems.
幼年特发性关节炎（JIA）的治疗方法存在差异，这可能会影响治疗质量。本研究的目的是确定并比较两个医疗体系中 JIA 的治疗方法。
通过电子邮件向加拿大（n=58）和德国/奥地利（n=172）的儿科风湿病专家发送了基于案例的短文，内容涉及寡关节炎和血清阴性多关节炎 JIA。使用描述性统计方法分析数据；使用单变量分析比较回答。
总回复率为 63%。医生在年龄、培训水平和从业年限方面具有可比性，加拿大的医生更多地在学术中心工作。对于初始治疗寡关节炎，两组中只有大约一半的医生使用关节内类固醇。德国医生更有可能在 NSAID 治疗无效的情况下开始 DMARD 治疗（p<0.001）。在初始 DMARD 治疗无效的情况下，加拿大医生更倾向于改用不同的 DMARD，而不是生物制剂。对于寡关节炎和多关节炎，分别有 86%和 90%的德国医生更喜欢常规物理治疗而不是家庭运动，而加拿大的比例分别为 14%和 15%。除了加拿大医生在治疗寡关节炎时更倾向于使用萘普生外，在 NSAID、关节内类固醇制剂、初始 DMARD 和初始生物制剂治疗方面没有发现显著差异。
DMARD 治疗寡关节炎和多关节炎的方法基本一致，可用性和资金显然会影响医生的选择。关节内类固醇的使用在医生群体中存在差异。在这两个医疗体系中，物理治疗具有根本不同的作用。
