Kerstens Floor G, Turkstra Franktien, Atalay Selma, van Vugt Richard M, Swearingen Christopher J, Yazici Yusuf
NYU Hospital for Joint Disease, New York, NY, USA; and Amsterdam Rheumatology & immunology Center | Reade, Amsterdam, The Netherlands.
Amsterdam Rheumatology & Immunology Center | Reade, Amsterdam, The Netherlands.
Clin Exp Rheumatol. 2017 Nov-Dec;35 Suppl 108(6):55-59. Epub 2017 Apr 13.
To assess adherence to published guidelines for the treatment of Behçet's syndrome (BS) in two geographic areas.
We extracted guideline statements from the 2008 EULAR recommendations. Adherence to these statements was evaluated retrospectively in both New York (USA) and Amsterdam (The Netherlands), by reviewing records from patients fulfilling the ISG criteria. We analysed data per statement and event, and divided data according to the year in which an event occurred. We compared events prior to 2009 to those after publication of the EULAR recommendations (2009 and later).
474 patients were evaluated, 24 of whom were from Amsterdam. Treatment adherence varied substantially across various Behçet's manifestations, ranging from 21% vs. 31% in posterior uveitis, 50% vs. 25% in arterial disease, 29% vs. 29% in arthritis and 38% vs. 55% in erythema nodosum to 65% vs. 67% in deep venous thrombosis (DVT), before and after publication of the guidelines respectively. Topical treatment of mucocutaneous disease was only 2% vs. 8%, whereas adherence in neuro-Behçet was ≥ 94% and 100% in gastrointestinal disease.
Adherence to treatment guidelines varies substantially by Behçet's manifestation. Lack of adherence in manifestations such as eye disease and arthritis suggests that current recommendations are not sufficient or other concurrent manifestations require more aggressive treatment. The extensive use of anti-TNF agents might indicate a shift towards more aggressive treatment. Thus, our results suggest the 2008 guidelines were not in line with treatment in clinical practice over the past years and the recent revision of the recommendations was indeed needed.
评估两个地理区域对白塞病（BS）治疗的已发表指南的遵循情况。
我们从2008年欧洲抗风湿病联盟（EULAR）的建议中提取指南声明。通过回顾符合国际白塞病研究组（ISG）标准患者的记录，在美国纽约和荷兰阿姆斯特丹对这些声明的遵循情况进行回顾性评估。我们按声明和事件分析数据，并根据事件发生年份对数据进行划分。我们比较了2009年之前的事件与EULAR建议发表后（2009年及以后）的事件。
共评估了474例患者，其中24例来自阿姆斯特丹。白塞病不同表现的治疗遵循情况差异很大，在葡萄膜炎中为21%对31%，在动脉疾病中为50%对25%，在关节炎中为29%对29%，在结节性红斑中为38%对55%，在深静脉血栓形成（DVT）中分别为65%对67%，分别为指南发表前后的数据。黏膜皮肤疾病的局部治疗仅为2%对8%，而神经白塞病的遵循率≥94%，胃肠道疾病为100%。
白塞病不同表现的治疗遵循情况差异很大。在眼部疾病和关节炎等表现中缺乏遵循表明当前建议不足或其他并发表现需要更积极的治疗。抗TNF药物的广泛使用可能表明治疗倾向于更积极。因此，我们的结果表明2008年指南与过去几年的临床实践治疗不一致，确实需要对建议进行近期修订。
