Castrejón Isabel, Chua Jacquelin R, Pincus Theodore
Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA.
Clin Exp Rheumatol. 2017 Sep-Oct;35 Suppl 107(5):21-25. Epub 2017 Sep 28.
A physician global assessment of patient status (DOCGL) was designed initially to quantitate inflammatory activity in rheumatoid arthritis (RA) clinical trials, in which patients are selected for high levels of activity. However, in patients seen in routine care with various diagnoses, and even in some RA patients selected for clinical trials, DOCGL also may be affected by joint damage and/or patient distress. To clarify DOCGL on a 0-10 visual analogue scale (VAS), 3 additional 0-10 VAS have been developed to record physician estimates of inflammation (DOCINF), damage (DOCDAM), and distress (DOCSTR) (such as fibromyalgia (FM)/depression). Results from 3 locales for these 4 VASs are summarised, including 478 initial-visit patients from Tennessee in 1996 to 2007, 197 initial-visit patients from Pennsylvania in 2008 to 2012, and a random visit of 739 patients from Illinois in 2014 to 2015. Highest DOCGL estimates were seen at the 3 sites in FM, followed by RA and osteoarthritis (OA), spondyloarthropathies (SpA), gout, and systemic lupus erythematosus (SLE). Highest DOCINF (inflammation) estimates were seen in RA and SpA, followed by gout, SLE, FM, and OA. Highest DOCDAM (damage) estimates were in OA, followed by RA, SpA, gout, SLE and FM. Highest DOCSTR (distress) estimates were in FM, followed by OA, RA, SpA, SLE, and gout. In the 2 earlier series, DOCDAM was considerably higher than DOCINF only in OA, and lower in the other diagnoses, although within 50% of DOCINF. In more recent patients from Illinois, mean DOCDAM was higher than DOCINF in all 6 diagnoses. The 0-10 physician VASs depict the expertise of a rheumatologist to distinguish between inflammation, damage and distress in an individual patient and rate levels as quantitative data beyond narrative descriptions. These VASs appear informative for rheumatology care, documentation, and research.
医生对患者状况的整体评估（DOCGL）最初旨在量化类风湿关节炎（RA）临床试验中的炎症活动，这类试验选取的患者炎症活动水平较高。然而，在接受常规护理的患有各种诊断疾病的患者中，甚至在一些入选临床试验的RA患者中，DOCGL也可能受到关节损伤和/或患者痛苦的影响。为了在0至10的视觉模拟量表（VAS）上明确DOCGL，又开发了另外3个0至10的VAS，用于记录医生对炎症（DOCINF）、损伤（DOCDAM）和痛苦（DOCSTR）（如纤维肌痛（FM）/抑郁症）的评估。总结了来自3个地区这4种VAS的结果，包括1996年至2007年来自田纳西州的478名初诊患者、2008年至2012年来自宾夕法尼亚州的197名初诊患者，以及2014年至2015年来自伊利诺伊州的739名随机就诊患者。在这3个地区，FM患者的DOCGL评估最高，其次是RA和骨关节炎（OA）、脊柱关节病（SpA）、痛风和系统性红斑狼疮（SLE）。DOCINF（炎症）评估最高的是RA和SpA，其次是痛风、SLE、FM和OA。DOCDAM（损伤）评估最高的是OA，其次是RA、SpA、痛风、SLE和FM。DOCSTR（痛苦）评估最高的是FM，其次是OA、RA、SpA、SLE和痛风。在较早的两个系列中，仅在OA中DOCDAM显著高于DOCINF，在其他诊断中则较低，尽管在DOCINF的50%以内。在伊利诺伊州的近期患者中，在所有6种诊断中DOCDAM的平均值均高于DOCINF。0至10的医生VAS描绘了风湿病学家区分个体患者炎症、损伤和痛苦的专业能力，并将水平评定为超出叙述性描述的定量数据。这些VAS似乎对风湿病护理、记录和研究具有参考价值。
