Lubrano Ennio, Cantini Fabrizio, Mathieu Alessandro, Olivieri Ignazio, Salvarani Carlo, Scarpa Raffaele, Marchesoni Antonio
Rheumatology Unit, Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy.
Division of Rheumatology, Hospital of Prato, Italy.
Clin Exp Rheumatol. 2017 Mar-Apr;35(2):214-220. Epub 2016 Aug 31.
OBJECTIVES: Accurate diagnosis and appropriate management of psoriatic arthritis (PsA) is essential to avoid unnecessary morbidity. Our aim in this study was to evaluate the current approach to the management of PsA among rheumatologists. METHODS: A 16-item online questionnaire, produced using the Delphi method, was submitted to a panel of rheumatologists who anonymously expressed their opinions on a scale from 1 (maximum disagreement) to 5 (maximum agreement). Positive consensus was defined by ≥66% of the respondents scoring an item 3, 4 or 5. Negative consensus was defined by ≥66% of the respondents scoring an item 1 or 2. RESULTS: The surveyed rheumatologists agreed that in its early stage, PsA is characterised by the involvement of few joints and/or entheses and that psoriasis, although possibly absent, will be present in a patient's past personal or family history. There was no consensus among the rheumatologists regarding normalisation of C-reactive protein levels and erythrocyte sedimentation rates defining remission. The specialists believed that clinical remission was achieved more frequently and for longer among patients with PsA than rheumatoid arthritis. The participants believed that neutralising antibodies altered the efficacy of anti-tumour necrosis factor agents and that monoclonal antibodies induced greater production of neutralising antibodies than receptor proteins. However, knowledge was somewhat lacking in relation to the prophylaxis of latent tuberculosis. CONCLUSIONS: The data collected showed that the surveyed rheumatologists had a good knowledge of the diagnosis of early-stage PsA and a good understanding of its management in relation to its clinical phenotype, with the exception of the form having predominantly axial involvement.
目的:准确诊断和恰当管理银屑病关节炎(PsA)对于避免不必要的发病至关重要。我们开展本研究的目的是评估风湿病学家目前对PsA的管理方法。 方法:采用德尔菲法编制了一份包含16个条目的在线问卷,并提交给一组风湿病学家,他们以1(最大程度不同意)至5(最大程度同意)的评分标准匿名表达意见。若≥66%的受访者将某一项目评为3、4或5分,则定义为达成积极共识。若≥66%的受访者将某一项目评为1或2分,则定义为达成消极共识。 结果:接受调查的风湿病学家一致认为,在早期阶段,PsA的特征是少数关节和/或附着点受累,并且银屑病,尽管可能不存在,但会出现在患者的个人既往史或家族史中。在定义缓解时,C反应蛋白水平和红细胞沉降率正常化方面,风湿病学家未达成共识。专家们认为,与类风湿关节炎相比,PsA患者更频繁且更持久地实现临床缓解。参与者认为,中和抗体改变了抗肿瘤坏死因子药物的疗效,并且单克隆抗体比受体蛋白诱导产生更多的中和抗体。然而,在潜伏性结核病的预防方面,知识有所欠缺。 结论:收集到的数据表明,接受调查的风湿病学家对早期PsA的诊断有较好的了解,并且对其基于临床表型的管理有较好的理解,但以主要累及中轴的类型为例外。
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