Nikiphorou Elena, Galloway James, van Riel Piet, Yazici Yusuf, Haugeberg Glenn, Ostor Andrew, Gogus Feride, Kauppi Markku, Sokka Tuulikki
Department of Rheumatology, Whittington Hospital, London, UK; and Jyväskylä Central Hospital, Rheumatology Unit, Jyväskylä, Finland.
King's College London, Academic Rheumatology Department, London, UK.
Clin Exp Rheumatol. 2017 May-Jun;35(3):477-483. Epub 2017 Jan 27.
To explore patterns of real-world early RA (ERA) care across countries.
An online survey was disseminated to practising rheumatologists across Europe and the US, also made accessible on social media between April and May 2015. Survey questions (n=38) assessed the structure and setting of ERA clinics, times to diagnosis and treatment, patient monitoring, guideline use and data recording.
A total of 212 rheumatologists from 39 countries (76% European) completed the survey. 62% had an ERA clinic based at a university hospital. Patient referral to rheumatology was mainly (78%) via primary care; 44% had an agreed ERA local referral pathway, 15% a national pathway. Only 16% had dedicated ERA clinics, the majority being practitioners in Northern Europe with access to a local or national referral pathway. Data for research were collected by 42%. Treatment guidelines were followed by the majority, especially rheumatologists practising in Europe. Variations existed in the use of initial DMARDs with treatment decisions reported to be influenced by international/national guidelines in 71%/61%. No significant relationship between country gross national income and the availability of ERA clinics was seen.
This study provides comparative benchmark information regarding the global provision of ERA care. Substantial variations exist in referral and early assessment pathways with guidelines having a most apparent impact in Northern Europe. Provision of an ERA service does not appear to be constrained by cost, with conceptual factors, e.g. clinician engagement, perhaps playing a role. These initial insights could potentially help harmonise ERA management across countries.
探索各国早期类风湿关节炎（ERA）的实际诊疗模式。
2015年4月至5月期间，向欧洲和美国的执业风湿病学家开展了一项在线调查，该调查在社交媒体上也可获取。调查问题（共38个）评估了ERA诊所的结构与设置、诊断和治疗时间、患者监测、指南使用及数据记录情况。
来自39个国家的212名风湿病学家（76%来自欧洲）完成了调查。62%的人在大学医院设有ERA诊所。患者转诊至风湿病科主要（78%）通过初级保健；44%有商定的ERA当地转诊途径，15%有全国转诊途径。只有16%设有专门的ERA诊所，大多数是北欧的从业者，他们可获得当地或全国转诊途径。42%的人收集研究数据。大多数人遵循治疗指南，尤其是在欧洲执业的风湿病学家。初始疾病改善抗风湿药物（DMARDs）的使用存在差异，71%/61%的治疗决策报告受国际/国家指南影响。未发现国家国民总收入与ERA诊所的可及性之间存在显著关系。
本研究提供了关于全球ERA诊疗服务的比较基准信息。转诊和早期评估途径存在显著差异，指南在北欧的影响最为明显。ERA服务的提供似乎不受成本限制，概念性因素（如临床医生参与度）可能发挥了作用。这些初步见解可能有助于各国协调ERA管理。
